Provider Demographics
NPI:1326011081
Name:GAUDREAU, NORMAND PAUL (RPH, CDE)
Entity Type:Individual
Prefix:MR
First Name:NORMAND
Middle Name:PAUL
Last Name:GAUDREAU
Suffix:
Gender:M
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KEACH LOOP
Mailing Address - Street 2:CORMORANT PASSAGE
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3000
Mailing Address - Country:US
Mailing Address - Phone:253-948-8007
Mailing Address - Fax:
Practice Address - Street 1:9040 A REID ST.
Practice Address - Street 2:MAMC-PHARMACY
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1950
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist