Healthcare Provider Details

I. General information

NPI: 1629786819
Provider Name (Legal Business Name): WILLIAM CODY EWING CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 100TH ST SW
LAKEWOOD WA
98499-2752
US

IV. Provider business mailing address

3215 S 47TH ST APT C59
TACOMA WA
98409-5510
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3666
  • Fax: 253-588-1922
Mailing address:
  • Phone: 541-813-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPT-0011393
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60994950
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: