Provider Demographics
NPI:1538253968
Name:VANEVENHOVEN, CAROL LYN (PHARMD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYN
Last Name:VANEVENHOVEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 WEST 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942
Mailing Address - Country:US
Mailing Address - Phone:509-249-5232
Mailing Address - Fax:509-575-8700
Practice Address - Street 1:2811 TIETON DRIVE
Practice Address - Street 2:YAKIMA VALLEY MEMORIAL HOSPITAL PHARMACY DEPT.
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-249-5232
Practice Address - Fax:509-575-8700
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00041599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist