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General NPI Number Information
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NPI Number | 1053406504
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Entity Type | Individual
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Provider Name | ROUL WOLFGANG CHWALEK R.PH.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9600 VETERANS DRIVE
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City | TACOMA
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State | WA
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Zip | 98493
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Country | US
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Telephone | 253-582-8440
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Fax | 253-583-2399
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Provider Business Mailing Address
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Address Line | 6911 42ND AVE CT NW
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-582-8440
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Fax | 253-583-2399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00011680
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License Number State | WA
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