Provider Demographics
NPI:1134489321
Name:LAKVOLD, LAURA B (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:LAKVOLD
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 1:23916 COUNTRY DR E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7238
Mailing Address - Country:US
Mailing Address - Phone:360-872-0245
Mailing Address - Fax:
Practice Address - Street 1:23916 COUNTRY DR E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7238
Practice Address - Country:US
Practice Address - Phone:360-872-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00061391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist