Provider Demographics
NPI:1356018493
Name:WALES, ABIGAIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:WALES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4139
Mailing Address - Country:US
Mailing Address - Phone:906-225-7953
Mailing Address - Fax:906-225-8792
Practice Address - Street 1:853 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4139
Practice Address - Country:US
Practice Address - Phone:906-225-7953
Practice Address - Fax:906-225-8792
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020047183500000X
MI5302040510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist