Provider Demographics
NPI:1790367894
Name:ADALE, ABENEZER (PHARM D)
Entity Type:Individual
Prefix:
First Name:ABENEZER
Middle Name:
Last Name:ADALE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 LAKE HEIGHTS DR APT Q103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6086
Mailing Address - Country:US
Mailing Address - Phone:314-398-3831
Mailing Address - Fax:
Practice Address - Street 1:1050 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1512
Practice Address - Country:US
Practice Address - Phone:509-665-7539
Practice Address - Fax:509-665-3180
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60898182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist