Healthcare Provider Details

I. General information

NPI: 1801017579
Provider Name (Legal Business Name): LANAE L WIATER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 N DIVISION ST
SPOKANE WA
99208-1207
US

IV. Provider business mailing address

47738 SUNSET HIGHWAY RD E
DAVENPORT WA
99122-9565
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-6010
  • Fax:
Mailing address:
  • Phone: 509-263-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0009315
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00051589
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: