Provider Demographics
NPI:1609241348
Name:VANDERVEER, LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VANDERVEER
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 1:4741 ALLIED RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2411
Mailing Address - Country:US
Mailing Address - Phone:914-475-1710
Mailing Address - Fax:
Practice Address - Street 1:1299 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4902
Practice Address - Country:US
Practice Address - Phone:619-441-8040
Practice Address - Fax:619-441-8078
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73969183500000X
CT12731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist