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General NPI Number Information
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NPI Number | 1215449483
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Entity Type | Individual
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Provider Name | JAE B. PAK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/28/2017
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Last Update Date | 10/28/2017
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Provider Practice Location Address
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Address Line | 3838 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4416
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Country | US
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Telephone | 253-564-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 4818 POINT FOSDICK DR NW
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City | GIG HARBOR
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State | WA
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Zip | 98335-1711
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Country | US
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Telephone | 253-851-3175
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Fax | 253-851-6953
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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 | PH60758209
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License Number State | WA
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