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General NPI Number Information
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NPI Number | 1215310776
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Entity Type | Individual
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Provider Name | JOHN POLNAK PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 209 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4265
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Country | US
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Telephone | 253-596-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 209 MARTIN LUTHER KING JR WAY
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City | TACOMA
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State | WA
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Zip | 98405-4265
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Country | US
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Telephone | 253-596-3300
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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 | 060413-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 0021305
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60764821
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License Number State | WA
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