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General NPI Number Information
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NPI Number | 1770173270
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Entity Type | Individual
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Provider Name | MONICA OM
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 3737 PACIFIC AVE
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City | TACOMA
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State | WA
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Zip | 98418-7827
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Country | US
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Telephone | 253-473-5217
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Fax |
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Provider Business Mailing Address
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Address Line | 231 CABOT ST APT 2R
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City | HOLYOKE
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State | MA
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Zip | 01040-3911
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Country | US
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Telephone | 413-530-3181
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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 | PH1072726
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License Number State | WA
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