=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073110581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCE PINAROC PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2020
-----------------------------------------------------
Last Update Date | 10/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 PT FOSDICK DR NW STE 250
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-530-8030
-----------------------------------------------------
Fax | 253-530-8024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4545 PT FOSDICK DR NW STE 250
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-530-8030
-----------------------------------------------------
Fax | 253-530-8024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | PH00054604
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------