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821 S 38th St Tacoma WA 98418-5028 | |
| (253) 473-1155 | |
| (253) 473-1158 |
| Full Name | |
|---|---|
| Speciality | Pharmacy |
| Location | 821 S 38th St, Tacoma, Washington |
| Authorized Official Name and Position | Patrick Kelly Odonnell (OWNER) |
| Authorized Official Contact | 2534731155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
821 S 38th St Tacoma WA 98418-5028 Ph: (253) 473-1155 | 821 S 38th St Tacoma WA 98418-5028 Ph: (253) 473-1155 |
| NPI Number | 1033120530 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 12/18/2024 |
| Medicare PECOS PAC ID | 6305874140 |
|---|---|
| Medicare Enrollment ID | O20050802000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033120530 | NPI | - | NPPES |
| 2107545 | Other | PK | |
| 6027601 | Medicaid | WA |
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