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NPI Code Detail

MEDICARE: DR. TONY JERROLD CASANOVA PHARM.D.

MEDICARE: DR. TONY JERROLD CASANOVA PHARM.D.
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
1183500000XPharmacistPH00056586WA
21835P1200XPharmacotherapy PharmacistPH00056586WA

General Provider Information

NPI Number : 1407846108
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TONY JERROLD CASANOVA PHARM.D.
Provider Business Mailing Address
First Line : 220 TACOMA AVE S
Second Line : #1207
City : TACOMA
State : WA
Zip : 98402-2529
Country : US
Telephone Number : 253-318-0853
Fax Number :
Provider Business Practice Location Address
First Line : 1717 S J ST
Second Line : ST. JOSEPH MEDICAL CENTER (INPATIENT PHARMACY)
City : TACOMA
State : WA
Zip : 98405-4933
Country : US
Telephone Number : 253-426-6692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 09/11/2025

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