Provider Demographics
NPI:1366892275
Name:IREDALE, RUTH B (RPH)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:B
Last Name:IREDALE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 E WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3517
Mailing Address - Country:US
Mailing Address - Phone:360-683-1156
Mailing Address - Fax:
Practice Address - Street 1:990 E WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3517
Practice Address - Country:US
Practice Address - Phone:360-683-1156
Practice Address - Fax:360-683-8532
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00022371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist