Provider Demographics
NPI:1023562360
Name:HOVDA, JACE DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:JACE
Middle Name:DOUGLAS
Last Name:HOVDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 WILLOW LN NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8113
Mailing Address - Country:US
Mailing Address - Phone:509-995-6839
Mailing Address - Fax:
Practice Address - Street 1:4840 BORGEN BLVD NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-6826
Practice Address - Country:US
Practice Address - Phone:253-853-9340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60651349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist