Provider Demographics
NPI:1073581955
Name:CHRISTIANSON, WAYNE M (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:M
Last Name:CHRISTIANSON
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 1:10231 N DAVIES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8568
Mailing Address - Country:US
Mailing Address - Phone:425-334-6137
Mailing Address - Fax:360-403-8846
Practice Address - Street 1:10231 N DAVIES RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258
Practice Address - Country:US
Practice Address - Phone:425-334-6137
Practice Address - Fax:360-403-8846
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist