Provider Demographics
NPI:1386956399
Name:CAPITAL ONCOLOGY PLLC
Entity type:Organization
Organization Name:CAPITAL ONCOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WYZIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-887-9333
Mailing Address - Street 1:3920 CAPITOL MALL DR SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8700
Mailing Address - Country:US
Mailing Address - Phone:360-753-4700
Mailing Address - Fax:360-753-6700
Practice Address - Street 1:121 N. DIVISION ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001
Practice Address - Country:US
Practice Address - Phone:253-887-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site