Provider Demographics
NPI:1629237722
Name:WNUK, STEPHANIE SR (CPHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WNUK
Suffix:SR
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4800
Mailing Address - Country:US
Mailing Address - Phone:425-235-9703
Mailing Address - Fax:425-793-1015
Practice Address - Street 1:4700 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4800
Practice Address - Country:US
Practice Address - Phone:425-235-9703
Practice Address - Fax:425-793-1015
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00064941183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician