Provider Demographics
NPI:1548770258
Name:CARMICHAEL, LAUREL WHITNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:WHITNEY
Last Name:CARMICHAEL
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 1:333 KELLER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2893
Mailing Address - Country:US
Mailing Address - Phone:585-208-7507
Mailing Address - Fax:
Practice Address - Street 1:389 S MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3507
Practice Address - Country:US
Practice Address - Phone:707-766-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist