Provider Demographics
NPI:1609413376
Name:MAUTHE, LAURIE FERGUSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:FERGUSON
Last Name:MAUTHE
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 1:5801 POLLARD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1830
Mailing Address - Country:US
Mailing Address - Phone:804-852-9565
Mailing Address - Fax:
Practice Address - Street 1:5801 POLLARD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1830
Practice Address - Country:US
Practice Address - Phone:804-852-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022053161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist