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General NPI Number Information
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NPI Number | 1083367106
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Entity Type | Individual
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Provider Name | JEROME KWAKU ATROR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 11012 CANYON RD E
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City | PUYALLUP
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State | WA
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Zip | 98373-4200
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Country | US
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Telephone | 253-537-1517
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 61ST AVE NE APT A104
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City | TACOMA
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State | WA
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Zip | 98422-3354
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Country | US
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Telephone | 253-507-0076
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Fax |
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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 | 051304362
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH61245518
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License Number State | WA
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