Provider Demographics
NPI:1316390149
Name:LEFAIVRE, CARLA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:LEFAIVRE
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 1:8 POWDER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6701
Mailing Address - Country:US
Mailing Address - Phone:307-350-9075
Mailing Address - Fax:
Practice Address - Street 1:201 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5782
Practice Address - Country:US
Practice Address - Phone:307-362-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist