Provider Demographics
NPI:1053406504
Name:CHWALEK, ROUL WOLFGANG (RPH)
Entity type:Individual
Prefix:
First Name:ROUL
Middle Name:WOLFGANG
Last Name:CHWALEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 42ND AVE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-582-8440
Mailing Address - Fax:253-583-2399
Practice Address - Street 1:9600 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-583-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist