Provider Demographics
NPI:1205182458
Name:GEDEFAW, ANDUALEM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDUALEM
Middle Name:
Last Name:GEDEFAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 S 289TH PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2832
Mailing Address - Country:US
Mailing Address - Phone:206-353-4809
Mailing Address - Fax:
Practice Address - Street 1:4632 S 289TH PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2832
Practice Address - Country:US
Practice Address - Phone:206-353-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60281955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist