Healthcare Provider Details

I. General information

NPI: 1316059454
Provider Name (Legal Business Name): JESSICA M LAVIGNE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEISS ST
SAGINAW MI
48602-5251
US

IV. Provider business mailing address

1500 WEISS ST
SAGINAW MI
48602-5251
US

V. Phone/Fax

Practice location:
  • Phone: 989-497-2500
  • Fax:
Mailing address:
  • Phone: 989-497-2500
  • Fax: 989-321-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302032981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: