Healthcare Provider Details

I. General information

NPI: 1710465976
Provider Name (Legal Business Name): FERNANDO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N COOK ST
SPOKANE WA
99207-5879
US

IV. Provider business mailing address

4001 N COOK ST
SPOKANE WA
99207-5879
US

V. Phone/Fax

Practice location:
  • Phone: 509-483-3427
  • Fax: 509-482-4040
Mailing address:
  • Phone: 509-483-3427
  • Fax: 509-482-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60841556
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: