Provider Demographics
NPI:1457335127
Name:TAEZA, DONNA PEARL (CPHT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:PEARL
Last Name:TAEZA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4619
Mailing Address - Country:US
Mailing Address - Phone:360-377-0743
Mailing Address - Fax:
Practice Address - Street 1:5500 OLYMPIC DR
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1487
Practice Address - Country:US
Practice Address - Phone:253-858-7455
Practice Address - Fax:253-858-7460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00046071183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician