MEDICARE: DR. TONYA M LASLO PHARMD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00050800	WA
2	1835P2201X	Ambulatory Care Pharmacist	PH00050800	WA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PH00050800	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WAPH00050800	OTHER	WA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1174742084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONYA M LASLO PHARMD.

Provider Business Mailing Address
First Line	:	14218 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-857-7797
Fax Number	:	253-857-7679

Provider Business Practice Location Address
First Line	:	14218 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-857-7797
Fax Number	:	253-857-7679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/13/2022

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