Provider Demographics
NPI:1982949277
Name:FERAN-HALVERSON, LAURIE A (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:FERAN-HALVERSON
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 1:2545 AMYS BND
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-5505
Mailing Address - Country:US
Mailing Address - Phone:262-681-3037
Mailing Address - Fax:
Practice Address - Street 1:4801 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4219
Practice Address - Country:US
Practice Address - Phone:262-637-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11390-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist