Provider Demographics
NPI:1245814185
Name:WARNKE, REBECCA (IMMUNIZER)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WARNKE
Suffix:
Gender:F
Credentials:IMMUNIZER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8182 NW LAWSTAD PL
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9043
Mailing Address - Country:US
Mailing Address - Phone:360-362-3681
Mailing Address - Fax:
Practice Address - Street 1:2860 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8513
Practice Address - Country:US
Practice Address - Phone:360-692-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00016843183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician