Healthcare Provider Details

I. General information

NPI: 1790007953
Provider Name (Legal Business Name): PAUL C OGU SR. BS PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14308 MERIDIAN E
PUYALLUP WA
98373-5613
US

IV. Provider business mailing address

14308 MERIDIAN E
PUYALLUP WA
98373-5613
US

V. Phone/Fax

Practice location:
  • Phone: 253-604-1051
  • Fax: 253-604-1057
Mailing address:
  • Phone: 253-604-1051
  • Fax: 253-604-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00018679
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: