Organization
UNION AVENUE COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM BURKES (OWNER)
(253) 752-1705
Entity
Organization
Contact information
Practice address
2302 S UNION AVE, C25, TACOMA, WA 98405-1300
(253) 752-1705
(253) 761-9315
Mailing address
2302 S UNION AVE, C25, TACOMA, WA 98405-1300
(253) 752-1705
(253) 761-9315
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
CF00057609
WA
3336C0003X
Community/Retail Pharmacy
Primary
CF00057609
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9014036
DME
WA
Enumeration date
03/19/2007
Last updated
05/26/2010
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