Provider Demographics
NPI:1205112257
Name:MANSKE, LYNN MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MANSKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3920
Mailing Address - Country:US
Mailing Address - Phone:360-253-7254
Mailing Address - Fax:360-253-7827
Practice Address - Street 1:9714 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3920
Practice Address - Country:US
Practice Address - Phone:360-253-7254
Practice Address - Fax:360-253-7827
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist