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General NPI Number Information
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NPI Number | 1457083883
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Entity Type | Individual
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Provider Name | ALEXA CONZUELO GABRIEL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 3601 6TH AVE
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City | TACOMA
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State | WA
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Zip | 98406-5405
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Country | US
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Telephone | 253-761-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 S STEVENS ST APT 16
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City | TACOMA
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State | WA
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Zip | 98405-1132
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Country | US
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Telephone | 253-754-1267
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | IR60965838
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License Number State | WA
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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 | PH61459531
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License Number State | WA
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