Provider Demographics
NPI:1790221836
Name:HRADIL, MARINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:HRADIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5525
Mailing Address - Country:US
Mailing Address - Phone:253-536-6257
Mailing Address - Fax:253-536-6261
Practice Address - Street 1:11225 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5525
Practice Address - Country:US
Practice Address - Phone:253-536-6257
Practice Address - Fax:253-536-6261
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00049495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist