Healthcare Provider Details

I. General information

NPI: 1083112346
Provider Name (Legal Business Name): NICOLE CASINGAL CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 S ALASKA ST
TACOMA WA
98408-1312
US

IV. Provider business mailing address

5809 S ALASKA ST
TACOMA WA
98408-1312
US

V. Phone/Fax

Practice location:
  • Phone: 253-970-9062
  • Fax: 253-970-9062
Mailing address:
  • Phone: 253-970-9062
  • 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: