Provider Demographics
NPI:1003240250
Name:OLDER, LOUISE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ANN
Last Name:OLDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4762
Mailing Address - Country:US
Mailing Address - Phone:509-325-8720
Mailing Address - Fax:509-325-7625
Practice Address - Street 1:3321 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4762
Practice Address - Country:US
Practice Address - Phone:509-325-8720
Practice Address - Fax:509-325-7625
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist