Healthcare Provider Details

I. General information

NPI: 1831773043
Provider Name (Legal Business Name): THOMAS JOEL BECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 E 29TH AVE
SPOKANE WA
99223-4811
US

IV. Provider business mailing address

PO BOX 1174
SPOKANE WA
99210-1174
US

V. Phone/Fax

Practice location:
  • Phone: 509-535-9056
  • Fax:
Mailing address:
  • Phone: 509-850-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60816262
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: