Provider Demographics
NPI:1992080279
Name:WALDE, MICHAEL ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:WALDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:6807 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5145
Mailing Address - Country:US
Mailing Address - Phone:425-438-9380
Mailing Address - Fax:425-438-2559
Practice Address - Street 1:6807 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5145
Practice Address - Country:US
Practice Address - Phone:425-438-9380
Practice Address - Fax:425-438-2559
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA10178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist