Healthcare Provider Details

I. General information

NPI: 1023393451
Provider Name (Legal Business Name): EHREN JACOB WAINWRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17633 HIGHWAY 99
LYNNWOOD WA
98037-3627
US

IV. Provider business mailing address

17633 HIGHWAY 99
LYNNWOOD WA
98037-3627
US

V. Phone/Fax

Practice location:
  • Phone: 425-743-7555
  • Fax:
Mailing address:
  • Phone: 425-743-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60078210
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: