Provider Demographics
NPI:1326348798
Name:WHYBARK, NEVADA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NEVADA
Middle Name:A
Last Name:WHYBARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19993 COULEE VIEW RD NE
Mailing Address - Street 2:
Mailing Address - City:ELECTRIC CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99123-9711
Mailing Address - Country:US
Mailing Address - Phone:509-633-1732
Mailing Address - Fax:
Practice Address - Street 1:101 GRAND COULEE HWY
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-5014
Practice Address - Country:US
Practice Address - Phone:509-633-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist