Healthcare Provider Details

I. General information

NPI: 1679209118
Provider Name (Legal Business Name): ANNA LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HERNDON
CLOVIS CA
93611-3830
US

IV. Provider business mailing address

1401 HERNDON
CLOVIS CA
93611-3830
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-1574
  • Fax:
Mailing address:
  • Phone: 559-322-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: