Provider Demographics
NPI:1235415167
Name:WALLANDER, LAURA M (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:WALLANDER
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 1:1191 WESTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2176
Mailing Address - Country:US
Mailing Address - Phone:920-725-3152
Mailing Address - Fax:920-725-3238
Practice Address - Street 1:1191 WESTOWNE DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2176
Practice Address - Country:US
Practice Address - Phone:920-725-3152
Practice Address - Fax:920-725-3238
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14667-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist