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General NPI Number Information
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NPI Number | 1114047412
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Entity Type | Individual
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Provider Name | THOMAS OSCAR MATICH RPH
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11225 PACIFIC AVE S
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City | TACOMA
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State | WA
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Zip | 98444-5525
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Country | US
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Telephone | 253-536-6257
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Fax | 253-536-6261
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Provider Business Mailing Address
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Address Line | 13622 SE 171ST PL
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City | RENTON
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State | WA
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Zip | 98058-7032
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Country | US
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Telephone | 425-277-2504
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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 | PH00015517
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License Number State | WA
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