Provider Demographics
NPI:1720564925
Name:ACTS PHARMACY AND HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ACTS PHARMACY AND HEALTHCARE SERVICES, LLC
Other - Org Name:ACTS PHARMACY AND HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:GOVERNOR/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAZEL JANE
Authorized Official - Middle Name:MANONGDO
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:253-306-0225
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:BLDG B STE 2011
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-272-0324
Mailing Address - Fax:
Practice Address - Street 1:1901 S UNION AVE BLDG B STE 2011
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-272-0324
Practice Address - Fax:253-272-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105021Medicaid
WAPHAR.CF.60864536OtherWA STATE DEPARTMENT OF HEALTH - PHARMACY LICENSE