Provider Demographics
NPI:1891024832
Name:WAMANSJAH, MARIA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WAMANSJAH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 S 144TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4045
Mailing Address - Country:US
Mailing Address - Phone:206-204-1284
Mailing Address - Fax:
Practice Address - Street 1:3716 S 144TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4045
Practice Address - Country:US
Practice Address - Phone:206-204-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00021696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist