Provider Demographics
NPI:1063858744
Name:LAFFIN, JEREMY P (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:P
Last Name:LAFFIN
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 1:4801 WAHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405
Mailing Address - Country:US
Mailing Address - Phone:262-637-8444
Mailing Address - Fax:262-637-0752
Practice Address - Street 1:4801 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4219
Practice Address - Country:US
Practice Address - Phone:262-637-8444
Practice Address - Fax:262-637-0752
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12414-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist