Provider Demographics
NPI:1841660701
Name:WILLDEN, STEVEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:WILLDEN
Suffix:
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 1:114 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7851
Mailing Address - Country:US
Mailing Address - Phone:360-452-4003
Mailing Address - Fax:
Practice Address - Street 1:114 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7851
Practice Address - Country:US
Practice Address - Phone:360-452-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60575492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist