Provider Demographics
NPI:1427454263
Name:PANELA, ROGER JR (RPH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:PANELA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 S 140TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4562
Mailing Address - Country:US
Mailing Address - Phone:206-246-8453
Mailing Address - Fax:253-735-0504
Practice Address - Street 1:5341 S 140TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4562
Practice Address - Country:US
Practice Address - Phone:206-246-8453
Practice Address - Fax:253-735-0504
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00041023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00041023OtherPHARMACIST LICENSE