Provider Demographics
NPI:1861731630
Name:WALDIE, ADELA CONSTANTIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ADELA
Middle Name:CONSTANTIN
Last Name:WALDIE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 FREMONT WAY
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2062
Mailing Address - Country:US
Mailing Address - Phone:509-895-4398
Mailing Address - Fax:
Practice Address - Street 1:5801 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3006
Practice Address - Country:US
Practice Address - Phone:509-965-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist