Healthcare Provider Details

I. General information

NPI: 1639271133
Provider Name (Legal Business Name): PAUL T JAQUISH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW PHARMACY 119A
TACOMA WA
98493-0003
US

IV. Provider business mailing address

9600 VETERANS DR SW PHARMACY 119A
TACOMA WA
98493-0003
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-2341
  • Fax: 253-589-4062
Mailing address:
  • Phone: 253-583-2341
  • Fax: 253-589-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH0001183
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: