Healthcare Provider Details

I. General information

NPI: 1023221173
Provider Name (Legal Business Name): ANIL DEOL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 PACIFIC AVE
TACOMA WA
98408-7220
US

IV. Provider business mailing address

1911 SW CAMPUS DR APT 325
FEDERAL WAY WA
98023-6473
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-8500
  • Fax: 253-474-0253
Mailing address:
  • Phone: 253-474-8500
  • Fax: 253-474-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00041857
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: