Basic Information
| Provider Information | |||||||||
| NPI: | 1336649102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALUCA | ||||||||
| FirstName: | CHUCK LEEVAN | ||||||||
| MiddleName: | FIGUERAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 S 89TH AVE # 2 | ||||||||
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| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989089351 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2811 TIETON DR | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095758000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2018 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | PH60684706 | WA | N | 1835P0018X | PH60684706 | WA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.