Provider Demographics
NPI:1700156932
Name:LAVERS, DIEDRE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIEDRE
Middle Name:
Last Name:LAVERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 VERDE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2742
Mailing Address - Country:US
Mailing Address - Phone:661-326-1396
Mailing Address - Fax:
Practice Address - Street 1:2119 VERDE ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2742
Practice Address - Country:US
Practice Address - Phone:661-326-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist