Provider Demographics
NPI:1215325311
Name:WANEK, JAMES RUSSELL (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RUSSELL
Last Name:WANEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1319 HIGHWAY 2
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2711
Mailing Address - Country:US
Mailing Address - Phone:208-263-9080
Mailing Address - Fax:208-255-1695
Practice Address - Street 1:1319 HIGHWAY 2
Practice Address - Street 2:SUITE A
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2711
Practice Address - Country:US
Practice Address - Phone:208-263-9080
Practice Address - Fax:208-255-1695
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist