MEDICARE: UNION AVENUE COMPOUNDING PHARMACY

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	332B00000X	Durable Medical Equipment & Medical Supplies	CF00057609	WA
2	3336C0003X	Community/Retail Pharmacy	CF00057609	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9014036	OTHER	WA	DME

General Provider Information

NPI Number	:	1881718674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION AVENUE COMPOUNDING PHARMACY

Provider Business Mailing Address
First Line	:	2302 S UNION AVE
Second Line	:	C25
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-1705
Fax Number	:	253-761-9315

Provider Business Practice Location Address
First Line	:	2302 S UNION AVE
Second Line	:	C25
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-1705
Fax Number	:	253-761-9315

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KIM BURKES
Credential	:
Telephone Number	:	253-752-1705

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/26/2010

Similar Medicare Providers

1154328300 — DR. ALAN F ALTMAN DDS, PC
Practice Location Address:

2302 S UNION AVE , SUITE A6
TACOMA, WA
98405-1300

Practice Phone: 253-752-4422
Practice Fax: 253-759-5724

1902806862 — GERALD S COLEMAN P.T.
Practice Location Address:

2302 S UNION AVE , SUITE B-10
TACOMA, WA
98405-1300

Practice Phone: 253-752-9303
Practice Fax: 253-756-7175

1841267242 — TACOMA PHYSICAL THERAPY INC PS
Practice Location Address:

2302 S UNION AVE , SUITE B-10
TACOMA, WA
98405-1300

Practice Phone: 253-752-9303
Practice Fax: 253-756-7175

1720055114 — MARILYN LEE MCKELVEY PT
Practice Location Address:

2302 S UNION AVE , SUITE B-10
TACOMA, WA
98405-1300

Practice Phone: 253-752-9303
Practice Fax: 253-756-7175

1033290903 — DAVID L MUGLESTON
Practice Location Address:

2302 S UNION AVE , SUITE A-2
TACOMA, WA
98405-1300

Practice Phone: 253-752-5933
Practice Fax: 253-752-6535

1598835118 — DR. DAVID FRANKLIN ANDREW D.D.S.
Practice Location Address:

2302 S UNION AVE , BUILDING B SUITE 12
TACOMA, WA
98405-1300

Practice Phone: 253-752-2447
Practice Fax: 253-752-2448

Directions to “UNION AVENUE COMPOUNDING PHARMACY ” Practice Location

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