Provider Demographics
NPI:1447542782
Name:SKARIAH, LINSO MARY (PH)
Entity type:Individual
Prefix:
First Name:LINSO
Middle Name:MARY
Last Name:SKARIAH
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13511 SE 3RD WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6990
Mailing Address - Country:US
Mailing Address - Phone:360-885-0839
Mailing Address - Fax:
Practice Address - Street 1:13511 SE 3RD WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6990
Practice Address - Country:US
Practice Address - Phone:360-885-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60151484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist