Provider Demographics
NPI:1932460060
Name:ISRAEL, DAVID SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:ISRAEL
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 1:1009 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2993
Mailing Address - Country:US
Mailing Address - Phone:360-825-9360
Mailing Address - Fax:360-825-9424
Practice Address - Street 1:1009 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2993
Practice Address - Country:US
Practice Address - Phone:360-825-9360
Practice Address - Fax:360-825-9424
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist