Provider Demographics
NPI:1962476846
Name:LAVANWAY, DON D (RPH)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:D
Last Name:LAVANWAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3001A SIXTH STREET
Mailing Address - Street 2:NHGL PHARMACY
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-1289
Mailing Address - Country:US
Mailing Address - Phone:847-688-2064
Mailing Address - Fax:847-688-4782
Practice Address - Street 1:3001A SIXTH STREET
Practice Address - Street 2:NAVAL HOSPITAL GREAT LAKES PHARMACY
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-1289
Practice Address - Country:US
Practice Address - Phone:847-688-2064
Practice Address - Fax:847-688-4782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist