Provider Demographics
NPI:1639271133
Name:JAQUISH, PAUL T (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:JAQUISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9600 VETERANS DR SW
Mailing Address - Street 2:PHARMACY 119A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0003
Mailing Address - Country:US
Mailing Address - Phone:253-583-2341
Mailing Address - Fax:253-589-4062
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:PHARMACY 119A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0003
Practice Address - Country:US
Practice Address - Phone:253-583-2341
Practice Address - Fax:253-589-4062
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011831835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy