Provider Demographics
NPI:1780906289
Name:LAIDO, DAWN K (RPH)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:LAIDO
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 1:2199 GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4581
Mailing Address - Country:US
Mailing Address - Phone:386-738-9610
Mailing Address - Fax:
Practice Address - Street 1:111 TOWN AND COUNTRY DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3962
Practice Address - Country:US
Practice Address - Phone:386-325-7562
Practice Address - Fax:386-326-0281
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0031280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist