Provider Demographics
NPI:1639483589
Name:DAWLY, LAURA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:DAWLY
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 1:18925 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-9361
Mailing Address - Country:US
Mailing Address - Phone:760-961-0112
Mailing Address - Fax:760-843-4104
Practice Address - Street 1:18925 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-9361
Practice Address - Country:US
Practice Address - Phone:760-961-0112
Practice Address - Fax:760-240-4371
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist