Provider Demographics
NPI:1942642251
Name:PICK, PHANYA (LMP)
Entity Type:Individual
Prefix:
First Name:PHANYA
Middle Name:
Last Name:PICK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 101ST STREET CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-3143
Mailing Address - Country:US
Mailing Address - Phone:253-682-9120
Mailing Address - Fax:
Practice Address - Street 1:8002 PORTLAND AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3349
Practice Address - Country:US
Practice Address - Phone:253-223-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60079248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist