Provider Demographics
NPI:1710497284
Name:MCFAUL, GERALD CONNER (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:CONNER
Last Name:MCFAUL
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 1:3909 10TH ST SE # 102
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2189
Mailing Address - Country:US
Mailing Address - Phone:253-848-2011
Mailing Address - Fax:253-848-3119
Practice Address - Street 1:3909 10TH ST SE # 102
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2189
Practice Address - Country:US
Practice Address - Phone:253-848-2011
Practice Address - Fax:253-848-3119
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60759918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist