Provider Demographics
NPI:1851708028
Name:MANNING, KJELENE CLAIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KJELENE
Middle Name:CLAIR
Last Name:MANNING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KJELENE
Other - Middle Name:CLAIR
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:218 UNITY ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4420
Mailing Address - Country:US
Mailing Address - Phone:360-752-7406
Mailing Address - Fax:360-312-5238
Practice Address - Street 1:218 UNITY ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4420
Practice Address - Country:US
Practice Address - Phone:360-752-7406
Practice Address - Fax:360-312-5238
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00065841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist