Provider Demographics
NPI:1811264021
Name:WALDRUP, ALISON
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:WALDRUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1002
Mailing Address - Country:US
Mailing Address - Phone:269-345-8507
Mailing Address - Fax:269-345-8516
Practice Address - Street 1:5020 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1002
Practice Address - Country:US
Practice Address - Phone:269-345-8507
Practice Address - Fax:269-345-8516
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist