Provider Demographics
NPI:1437588431
Name:VANLAANEN, MICHAEL AYRES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AYRES
Last Name:VANLAANEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NE 43RD ST
Mailing Address - Street 2:#205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6013
Mailing Address - Country:US
Mailing Address - Phone:206-375-3699
Mailing Address - Fax:
Practice Address - Street 1:12822 124TH LN NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7612
Practice Address - Country:US
Practice Address - Phone:425-814-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60225981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist