Active NPI
John Polnak, PHARMD.
- Pharmacist
- Tacoma, WA
National Provider Identifier
1215310776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60764821
- Practice address
- 209 Martin Luther King Jr Way
Tacoma, WA 98405-4265 - Phone
- (253) 596-3300
- NPI assigned
- Jul 2, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 060413-1 | NY | |
| Ambulatory Care Pharmacist | 1835P2201X | 0021305 | CO | |
| Pharmacist | 183500000X | PH60764821 | WA | Primary |
Addresses
Primary practice location
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Mailing address
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone (253) 596-3300
Other practice location 1
209 Martin Luther King Jr Way
Tacoma, WA 98405-4265
Phone (253) 596-3656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 060413-1 | NY | MD | Pharmacist |
| PH60764821 | WA | MD | Pharmacist |
| 0021305 | CO | MD | Ambulatory Care Pharmacist |
Interoperability endpoints
- jpolnak182034@ghc.direct-ci.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1215310776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 MARTIN LUTHER KING JR WAY",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054265",
"telephone_number": "253-596-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 MARTIN LUTHER KING JR WAY",
"city": "TACOMA",
"state": "WA",
"postal_code": "984054265",
"telephone_number": "253-596-3300"
}
],
"practiceLocations": [
{
"address_1": "209 Martin Luther King Jr Way",
"address_purpose": "LOCATION",
"city": "Tacoma",
"state": "WA",
"postal_code": "984054265",
"country_code": "US",
"telephone_number": "253-596-3656",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POLNAK",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "060413-1",
"primary": false
},
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "CO",
"license": "0021305",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60764821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.