Provider Demographics
NPI:1023393451
Name:WAINWRIGHT, EHREN JACOB
Entity Type:Individual
Prefix:
First Name:EHREN
Middle Name:JACOB
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17633 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3627
Mailing Address - Country:US
Mailing Address - Phone:425-743-7555
Mailing Address - Fax:
Practice Address - Street 1:17633 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3627
Practice Address - Country:US
Practice Address - Phone:425-743-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60078210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist