Healthcare Provider Details

I. General information

NPI: 1194314336
Provider Name (Legal Business Name): MICHAEL GLOCKLING JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

1761 N JACKSON AVE
TACOMA WA
98406-1130
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-3580
  • Fax:
Mailing address:
  • Phone: 509-710-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH60148801
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: