Provider Demographics
NPI:1982798062
Name:WYNN, CRAIG STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:STEVEN
Last Name:WYNN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5012
Mailing Address - Country:US
Mailing Address - Phone:360-493-4572
Mailing Address - Fax:360-493-5404
Practice Address - Street 1:3333 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5012
Practice Address - Country:US
Practice Address - Phone:360-493-4572
Practice Address - Fax:360-493-5404
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000161351835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric