Provider Demographics
NPI:1649526328
Name:MENSIK, JAMES DANIEL
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:MENSIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 OLYMPIC PL NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5094
Mailing Address - Country:US
Mailing Address - Phone:360-403-3378
Mailing Address - Fax:360-403-8846
Practice Address - Street 1:20500 OLYMPIC PL NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-5094
Practice Address - Country:US
Practice Address - Phone:360-403-3378
Practice Address - Fax:360-403-8846
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH70392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist