Individual
MR. COENRAAD JACOBUS VANDENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 MILITARY RD E, TACOMA, WA 98445-1243
(253) 538-2611
(253) 538-4918
Mailing address
104 MILITARY RD E, TACOMA, WA 98445-1243
(253) 538-2611
(253) 538-4918
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00050052
WA
Other
Enumeration date
06/20/2012
Last updated
06/20/2012
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