Provider Demographics
NPI:1740407345
Name:AVILA, GEORGE A (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:AVILA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719B 12TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5926
Mailing Address - Country:US
Mailing Address - Phone:425-218-8953
Mailing Address - Fax:
Practice Address - Street 1:18600B 33RD AVE W.
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037
Practice Address - Country:US
Practice Address - Phone:425-771-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist