Provider Demographics
NPI:1932810298
Name:AARDAL, KEVIN SCOTT (RXT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:AARDAL
Suffix:
Gender:M
Credentials:RXT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4141
Mailing Address - Country:US
Mailing Address - Phone:509-554-3653
Mailing Address - Fax:509-943-9090
Practice Address - Street 1:1329 LEE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4141
Practice Address - Country:US
Practice Address - Phone:509-554-3653
Practice Address - Fax:509-943-9090
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61179821183500000X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No183500000XPharmacy Service ProvidersPharmacist