Provider Demographics
NPI:1043500325
Name:WALDAL, ANDREW L (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:WALDAL
Suffix:
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 1:22100 NE HIGHWAY 240
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7300
Mailing Address - Country:US
Mailing Address - Phone:503-538-0295
Mailing Address - Fax:
Practice Address - Street 1:998 LIBRARY CT RM 4
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-557-3051
Practice Address - Fax:503-557-3052
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist