Individual
OLIVER CUSTODIO DIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
9040 A JACKSON AVE, TACOMA, WA 98431-0001
(253) 968-2586
Mailing address
4303 S 289TH PL, AUBURN, WA 98001-2830
(206) 612-4481
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
RPH44850
CA
183500000X
Pharmacist
RPH50999
WA
1835P2201X
Ambulatory Care Pharmacist
Primary
WA50999
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH44850
REGISTERED PHARMACIST
CA
01
—
RPH50999
REGISTERED PHARMACIST
WA
Enumeration date
11/03/2017
Last updated
06/16/2018
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