Healthcare Provider Details

I. General information

NPI: 1811644552
Provider Name (Legal Business Name): BRANDON THOMAS JOHNS PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 COOPER POINT RD NW
OLYMPIA WA
98502-4436
US

IV. Provider business mailing address

PO BOX 94
COSMOPOLIS WA
98537-0094
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-8014
  • Fax:
Mailing address:
  • Phone: 360-589-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60365746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: