Healthcare Provider Details

I. General information

NPI: 1790221836
Provider Name (Legal Business Name): MARINA HRADIL R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 PACIFIC AVE S
TACOMA WA
98444-5525
US

IV. Provider business mailing address

11225 PACIFIC AVE S
TACOMA WA
98444-5525
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-6257
  • Fax: 253-536-6261
Mailing address:
  • Phone: 253-536-6257
  • Fax: 253-536-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00049495
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: