Provider Demographics
NPI:1831269331
Name:WAWRINOFSKY, LYNN I (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:I
Last Name:WAWRINOFSKY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 FREE LAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4644
Mailing Address - Country:US
Mailing Address - Phone:801-566-0134
Mailing Address - Fax:
Practice Address - Street 1:597 FREE LAND AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4644
Practice Address - Country:US
Practice Address - Phone:801-566-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1409758911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist