Provider Demographics
NPI:1619974995
Name:UNDERWOOD, MARK TODD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TODD
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5235 RAY NASH DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5975
Mailing Address - Country:US
Mailing Address - Phone:253-265-8611
Mailing Address - Fax:253-265-8272
Practice Address - Street 1:9601 STEILACOOM BLVD SW
Practice Address - Street 2:PHARMACY SERVICES
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498-7213
Practice Address - Country:US
Practice Address - Phone:253-761-3390
Practice Address - Fax:253-756-2707
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000181911835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric