Provider Demographics
NPI:1093087082
Name:WALDAL, FLORENCE ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:ANNE
Last Name:WALDAL
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 1:12959 SW MORNINGSTAR DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1770
Mailing Address - Country:US
Mailing Address - Phone:503-590-2336
Mailing Address - Fax:
Practice Address - Street 1:12959 SW MORNINGSTAR DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-1770
Practice Address - Country:US
Practice Address - Phone:503-590-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist