Healthcare Provider Details

I. General information

NPI: 1811260912
Provider Name (Legal Business Name): MR. VIJAY KAZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SLEATER KINNEY RD SE PHARMACY
LACEY WA
98503-1150
US

IV. Provider business mailing address

9336 DEUCE CT NE
LACEY WA
98516-5202
US

V. Phone/Fax

Practice location:
  • Phone: 360-438-6483
  • Fax: 360-438-6477
Mailing address:
  • Phone: 360-951-7538
  • Fax: 360-282-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60028550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: