Healthcare Provider Details

I. General information

NPI: 1407846108
Provider Name (Legal Business Name): TONY JERROLD CASANOVA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST ST. JOSEPH MEDICAL CENTER (INPATIENT PHARMACY)
TACOMA WA
98405-4933
US

IV. Provider business mailing address

220 TACOMA AVE S #1207
TACOMA WA
98402-2529
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6692
  • Fax:
Mailing address:
  • Phone: 253-318-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00056586
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00056586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: