| NPI | 1144859638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00017744) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: WA PH00017744) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA PH00017744) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: WA PH00017744) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: WA PH00017744) | |
| 3336I0012X Pharmacy, Institutional Pharmacy (Licence: WA PH00017744) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: WA PH00017744) | |
| 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: WA PH00017744) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2020-04-06 |