Healthcare Provider Details

I. General information

NPI: 1215260740
Provider Name (Legal Business Name): MONICA J KWAK PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE DEPARTMENT OF PHARMACY
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON AVE DEPARTMENT OF PHARMACY
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60100322
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60100322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: