Provider Demographics
NPI:1093016230
Name:WAHL, GENEVIEVE CHUN HWA (BSPHARM)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:CHUN HWA
Last Name:WAHL
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6194 SW MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-672-8186
Mailing Address - Fax:503-672-8188
Practice Address - Street 1:6194 SW MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-4420
Practice Address - Country:US
Practice Address - Phone:503-672-8186
Practice Address - Fax:503-672-8188
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist