Rankos Stadium Pharmacy
NPI # 1710092762
101 N Tacoma Ave Tacoma, WA 98403 tel: 253-383-2411 / fax: 253-572-4329
[] Vaccine: Moderna COVID -19 LOT: EXPIRATION: NDC: 80777027310
[] Vaccine: Janssen COVID -19 LOT: EXPIRATION:
Inject 0.5 ml intramuscularly into deltoid now Site: Lt deltoid / Rt deltoid
Immunizer:__________________ Time Administered:________
Substitution Permitted:_______________ Dispense as Written:______________
Elizabeth Rankos, PharmD [] NPI: 1588914428
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