Provider Demographics
NPI:1831701986
Name:EVERSAUL, AARON WADE JR (PHARMD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:WADE
Last Name:EVERSAUL
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-0122
Mailing Address - Country:US
Mailing Address - Phone:253-278-9631
Mailing Address - Fax:
Practice Address - Street 1:1201 VALLEY AVE E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3225
Practice Address - Country:US
Practice Address - Phone:253-826-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61076339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist