Healthcare Provider Details

I. General information

NPI: 1528030657
Provider Name (Legal Business Name): MICHAEL JOSEPH BONCK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

4325 COUNTRY CLUB DR NE
TACOMA WA
98422-4612
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6692
  • Fax: 253-426-4949
Mailing address:
  • Phone: 253-922-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: