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General NPI Number Information
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NPI Number | 1972608792
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Entity Type | Individual
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Provider Name | DWIGHT ALDEN WAHLBORG RPH
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | PSHCS 9600 VETERAN S DR ATTN; (119)
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City | TACOMA
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State | WA
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Zip | 98493-0001
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Country | US
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Telephone | 253-583-2349
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Fax | 253-589-4062
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Provider Business Mailing Address
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Address Line | 4747 45TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98116-4403
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Country | US
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Telephone | 206-937-2386
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PH00011230
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License Number State | WA
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