Provider Demographics
NPI:1275075012
Name:ERLEWINE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ERLEWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 NW GRASS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-4001
Mailing Address - Country:US
Mailing Address - Phone:360-798-7984
Mailing Address - Fax:
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-514-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH600215061835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology