Individual
CLETUS LESIA GANA FOMBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH 60759925
Contact information
Practice address
702 TROSPER RD SW, TUMWATER, WA 98512
(360) 943-5178
Mailing address
702 TROSPER RD SW, TUMWATER, WA 98512-6934
(360) 943-5178
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60759925
WA
Other
Enumeration date
09/22/2017
Last updated
07/21/2022
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