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1023371440
COENRAAD JACOBUS VANDENBERG
TACOMA, WA
NPI
1023371440
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
183500000X Pharmacist
(Licence: WA PH00050052)
Enumeration Date
2012-06-20
Last Update Date
2012-06-20
Business Address
Mr. COENRAAD JACOBUS VANDENBERG
104 MILITARY RD E
TACOMA, WA 98445-1243
Phone number: 253-538-2611
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Mailing Address
Mr. COENRAAD JACOBUS VANDENBERG
104 MILITARY RD E
TACOMA, WA 98445-1243
Phone number: 253-538-2611
Copy
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