Healthcare Provider Details

I. General information

NPI: 1841866142
Provider Name (Legal Business Name): JILL RENEE WOEHL CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 N PEARL ST
TACOMA WA
98406-2457
US

IV. Provider business mailing address

6325 GREGORY ST W
UNIVERSITY PLACE WA
98466-5844
US

V. Phone/Fax

Practice location:
  • Phone: 253-879-0140
  • Fax: 253-879-0273
Mailing address:
  • Phone: 253-651-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00041668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: