Provider Demographics
NPI:1760882484
Name:CAVAILLE, RORY DAVID (PHARMD/PA-C)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:DAVID
Last Name:CAVAILLE
Suffix:
Gender:M
Credentials:PHARMD/PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NE 110TH ST APT 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6855
Mailing Address - Country:US
Mailing Address - Phone:360-350-2546
Mailing Address - Fax:
Practice Address - Street 1:275 BRONSON WAY NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4030
Practice Address - Country:US
Practice Address - Phone:425-235-2808
Practice Address - Fax:425-235-2835
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60797612363A00000X
WAIR60302565390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant