Basic Information
| Provider Information | |||||||||
| NPI: | 1003000993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMANNIS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 N 45TH ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981036305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307030373 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 117 SW 160TH STREET | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062422030 | ||||||||
| FaxNumber: | 2062422018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60444168 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 03129498 | OH | N | Pharmacy Service Providers | Pharmacist |
No ID Information.