Provider Demographics
NPI:1508960519
Name:LAFFERTY, MICHAEL D (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3815
Mailing Address - Country:US
Mailing Address - Phone:206-783-5133
Mailing Address - Fax:
Practice Address - Street 1:5312 17TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3815
Practice Address - Country:US
Practice Address - Phone:206-783-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist