Healthcare Provider Details

I. General information

NPI: 1629682984
Provider Name (Legal Business Name): TESSA STYCZINSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SE 192ND AVE
VANCOUVER WA
98683-1436
US

IV. Provider business mailing address

19037 BEDFORD DR
OREGON CITY OR
97045-4245
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-3043
  • Fax:
Mailing address:
  • Phone: 707-601-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number61008048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: