Provider Demographics
NPI:1073159901
Name:ALLRED, CARLA ALLDREDGE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ALLDREDGE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1107
Mailing Address - Country:US
Mailing Address - Phone:509-584-0300
Mailing Address - Fax:509-584-0302
Practice Address - Street 1:633 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1107
Practice Address - Country:US
Practice Address - Phone:509-584-0300
Practice Address - Fax:509-584-0302
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist