Healthcare Provider Details

I. General information

NPI: 1215310776
Provider Name (Legal Business Name): JOHN POLNAK PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

IV. Provider business mailing address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax:
Mailing address:
  • Phone: 253-596-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number060413-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0021305
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60764821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: