Provider Demographics
NPI:1265410104
Name:STEPHENS, LYNN E (CPHT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21633 99TH AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2002
Mailing Address - Country:US
Mailing Address - Phone:253-813-9549
Mailing Address - Fax:
Practice Address - Street 1:14277 INTERNATIONAL BLVD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4124
Practice Address - Country:US
Practice Address - Phone:206-431-9652
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA140103594043011183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician