Healthcare Provider Details

I. General information

NPI: 1528322344
Provider Name (Legal Business Name): DUANE BRYANT STOWERS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DJ STOWERS

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 6TH AVE
TACOMA WA
98406-5405
US

IV. Provider business mailing address

3601 6TH AVE
TACOMA WA
98406-5405
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-1248
  • Fax: 253-761-7462
Mailing address:
  • Phone: 253-761-1248
  • Fax: 253-761-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60017372
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: