Provider Demographics
NPI:1376936765
Name:PERKINS, MANUELA (RPH CGP)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RPH CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 MANOR WAY
Mailing Address - Street 2:C8
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6240
Mailing Address - Country:US
Mailing Address - Phone:206-747-1636
Mailing Address - Fax:
Practice Address - Street 1:2902 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3201
Practice Address - Country:US
Practice Address - Phone:425-741-7750
Practice Address - Fax:425-259-8600
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH301695431835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric