Provider Demographics
NPI:1629694690
Name:WAKEM, BRITNE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRITNE
Middle Name:LYNN
Last Name:WAKEM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRITNE
Other - Middle Name:LYNN
Other - Last Name:WAKEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KLUPENGER
Mailing Address - Street 1:4709 BLACKBERRY CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5984
Mailing Address - Country:US
Mailing Address - Phone:360-250-3633
Mailing Address - Fax:
Practice Address - Street 1:110 W K ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2944
Practice Address - Country:US
Practice Address - Phone:360-545-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60574901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA457486OtherNABP