Provider Demographics
NPI:1396153987
Name:KOLLAJA, ALVIN
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:KOLLAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15727 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9544
Mailing Address - Country:US
Mailing Address - Phone:509-922-3373
Mailing Address - Fax:509-926-4095
Practice Address - Street 1:15727 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9544
Practice Address - Country:US
Practice Address - Phone:509-922-3373
Practice Address - Fax:509-926-4095
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60256570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist