Provider Demographics
NPI:1144772419
Name:LAXSON, SHAWNA L (RPH)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:LAXSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5741
Mailing Address - Country:US
Mailing Address - Phone:503-284-1159
Mailing Address - Fax:503-281-1211
Practice Address - Street 1:7206 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5741
Practice Address - Country:US
Practice Address - Phone:503-284-1159
Practice Address - Fax:503-281-1211
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008687183500000X
WAPH00022210183500000X
CARPH456974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist