Provider Demographics
NPI:1780127019
Name:MINN, ANN L
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:MINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 HARBOUR POINTE BLVD APT N104
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5179
Mailing Address - Country:US
Mailing Address - Phone:206-375-0037
Mailing Address - Fax:
Practice Address - Street 1:16423 LARCH WAY
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8108
Practice Address - Country:US
Practice Address - Phone:425-741-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60666336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist