Healthcare Provider Details

I. General information

NPI: 1740340918
Provider Name (Legal Business Name): LAURA ANN WOLVERTON RPH, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING STREET NW ROOM C1102
WASHINGTON DC
20010-2975
US

IV. Provider business mailing address

110 IRVING STREET NW ROOM C1102
WASHINGTON DC
20010-2975
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7858
  • Fax: 202-877-4553
Mailing address:
  • Phone: 202-877-7858
  • Fax: 202-877-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041712
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH2190
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH2190
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: