Provider Demographics
NPI:1720294655
Name:WILTSE, RONALD ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALAN
Last Name:WILTSE
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 1:2160 E SPENCER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8892
Mailing Address - Country:US
Mailing Address - Phone:360-432-9047
Mailing Address - Fax:
Practice Address - Street 1:9601 BUJACICH RD NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8300
Practice Address - Country:US
Practice Address - Phone:253-858-4280
Practice Address - Fax:253-858-4258
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017270183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy