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General NPI Number Information
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NPI Number | 1144859638
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Entity Type | Individual
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Provider Name | PONCIANO F BAUTISTA
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 4002 49TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-1228
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Country | US
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Telephone | 206-834-5647
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Fax |
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Provider Business Mailing Address
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Address Line | 4002 49TH AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-1228
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Country | US
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Telephone | 206-834-5647
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Fax | 206-323-9206
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #7
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PH00017744
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License Number State | WA
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Taxonomy #8
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00017744
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License Number State | WA
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