Active NPI
Dwight Alden Wahlborg, RPH
- Pharmacotherapy Pharmacist
- Tacoma, WA
National Provider Identifier
1972608792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- PH00011230
- Practice address
- Pshcs 9600 Veteran S Dr
Attn; (119)
Tacoma, WA 98493-0001 - Phone
- (253) 583-2349
- Fax
- (253) 589-4062
- NPI assigned
- Sep 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | PH00011230 | WA | Primary |
Addresses
Primary practice location
Pshcs 9600 Veteran S Dr
Attn; (119)
Tacoma, WA 98493-0001
Mailing address
4747 45TH Ave SW
Seattle, WA 98116-4403
Phone (206) 937-2386
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00011230 | WA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972608792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4747 45TH AVE SW",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981164403",
"telephone_number": "206-937-2386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PSHCS 9600 VETERAN S DR",
"address_2": "ATTN; (119)",
"city": "TACOMA",
"state": "WA",
"postal_code": "984930001",
"telephone_number": "253-583-2349",
"fax_number": "253-589-4062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAHLBORG",
"first_name": "DWIGHT",
"middle_name": "ALDEN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "WA",
"license": "PH00011230",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.