Provider Demographics
NPI:1740340918
Name:WOLVERTON, LAURA ANN (RPH, BCOP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:RPH, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 IRVING STREET NW
Mailing Address - Street 2:ROOM C1102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2975
Mailing Address - Country:US
Mailing Address - Phone:202-877-7858
Mailing Address - Fax:202-877-4553
Practice Address - Street 1:110 IRVING STREET NW
Practice Address - Street 2:ROOM C1102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2975
Practice Address - Country:US
Practice Address - Phone:202-877-7858
Practice Address - Fax:202-877-4553
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041712183500000X
DCPH2190183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology