Healthcare Provider Details

I. General information

NPI: 1063996007
Provider Name (Legal Business Name): TOM RICHARD MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 09/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 360-521-3183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: