Provider Demographics
NPI:1467771451
Name:SPRAGUE, TOMMY JAMES
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:JAMES
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 100TH ST SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2708
Mailing Address - Country:US
Mailing Address - Phone:253-588-3666
Mailing Address - Fax:253-588-1922
Practice Address - Street 1:5700 100TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2708
Practice Address - Country:US
Practice Address - Phone:253-588-3666
Practice Address - Fax:253-588-1922
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00021120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist