Provider Demographics
NPI:1952441818
Name:AVE, ALVIN K
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:K
Last Name:AVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1822
Mailing Address - Country:US
Mailing Address - Phone:253-535-5615
Mailing Address - Fax:
Practice Address - Street 1:2111 S 90TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1822
Practice Address - Country:US
Practice Address - Phone:253-535-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist