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General NPI Number Information
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NPI Number | 1578955282
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE WELLNESS NETWORK, INC.
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 320 E 32ND ST UNIT 507
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City | TACOMA
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State | WA
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Zip | 98404-1609
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Country | US
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Telephone | 253-202-3720
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Fax |
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Provider Business Mailing Address
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Address Line | 320 E 32ND ST UNIT 507
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City | TACOMA
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State | WA
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Zip | 98404-1609
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Country | US
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Telephone | 253-202-3720
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON FURBUSH
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Credential | PHARM.D
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Telephone | 253-202-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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