Healthcare Provider Details

I. General information

NPI: 1619974995
Provider Name (Legal Business Name): MARK TODD UNDERWOOD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 STEILACOOM BLVD SW PHARMACY SERVICES
TACOMA WA
98498-7213
US

IV. Provider business mailing address

5235 RAY NASH DR NW
GIG HARBOR WA
98335-5975
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-3390
  • Fax: 253-756-2707
Mailing address:
  • Phone: 253-265-8611
  • Fax: 253-265-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH00018191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: