Provider Demographics
NPI:1568802205
Name:UDELHOVEN, ADRIENNE LEE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:LEE
Last Name:UDELHOVEN
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 1:1520 EASTLAKE AVE E
Mailing Address - Street 2:APT #306
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3748
Mailing Address - Country:US
Mailing Address - Phone:406-380-0074
Mailing Address - Fax:
Practice Address - Street 1:1520 EASTLAKE AVE E
Practice Address - Street 2:APT #306
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3748
Practice Address - Country:US
Practice Address - Phone:406-380-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist