Healthcare Provider Details

I. General information

NPI: 1174895486
Provider Name (Legal Business Name): PATRICIA A CHAROCHAK, D.O. P.S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 112TH STREET CT E
PUYALLUP WA
98373-7815
US

IV. Provider business mailing address

8112 112TH STREET CT E
PUYALLUP WA
98373-7815
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-5555
  • Fax: 253-848-5922
Mailing address:
  • Phone: 253-848-5555
  • Fax: 253-848-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberOP00000826
License Number StateWA

VIII. Authorized Official

Name: DR. PATRICIA A CHAROCHAK
Title or Position: DOCTOR
Credential: DO
Phone: 253-848-5555