Provider Demographics
NPI:1467682997
Name:WADDELL, ALAINA DANIELE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ALAINA
Middle Name:DANIELE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 MILTONDALE RD
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-5565
Mailing Address - Country:US
Mailing Address - Phone:904-655-7671
Mailing Address - Fax:904-259-5275
Practice Address - Street 1:1436 STATE ROAD 121 SOUTH
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-5565
Practice Address - Country:US
Practice Address - Phone:904-259-5824
Practice Address - Fax:904-259-5275
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL420101071242693183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician