Provider Demographics
NPI:1760508634
Name:RAUVOLA, EDWARD JOHN JR (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:RAUVOLA
Suffix:JR
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 1:106 W MANSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8651
Mailing Address - Country:US
Mailing Address - Phone:509-682-4087
Mailing Address - Fax:509-682-3452
Practice Address - Street 1:106 W MANSON HWY
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8651
Practice Address - Country:US
Practice Address - Phone:509-682-4087
Practice Address - Fax:509-682-3452
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist