Provider Demographics
NPI:1730163973
Name:EGERTON-CABALLES, GAIL DELA CRUZ (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DELA CRUZ
Last Name:EGERTON-CABALLES
Suffix:
Gender:F
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 27055
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98165-1455
Mailing Address - Country:US
Mailing Address - Phone:206-715-3534
Mailing Address - Fax:
Practice Address - Street 1:6401 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6754
Practice Address - Country:US
Practice Address - Phone:206-525-3754
Practice Address - Fax:206-523-3741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH56191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6033104Medicaid
WA4906357OtherNABP
WAAT0976615OtherPHARMACY DEA
WA6033104Medicaid