Provider Demographics
NPI:1629786819
Name:EWING, WILLIAM CODY (CPHT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY
Last Name:EWING
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 S 47TH ST APT C59
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5510
Mailing Address - Country:US
Mailing Address - Phone:541-813-9184
Mailing Address - Fax:
Practice Address - Street 1:5700 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2752
Practice Address - Country:US
Practice Address - Phone:253-588-3666
Practice Address - Fax:253-588-1922
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0011393183700000X
WAVA60994950183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician