Provider Demographics
NPI:1114047412
Name:MATICH, THOMAS OSCAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:OSCAR
Last Name:MATICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13622 SE 171ST PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7032
Mailing Address - Country:US
Mailing Address - Phone:425-277-2504
Mailing Address - Fax:
Practice Address - Street 1:11225 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5525
Practice Address - Country:US
Practice Address - Phone:253-536-6257
Practice Address - Fax:253-536-6261
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist