MEDICARE: MS. LAURA ANN WOLVERTON RPH, BCOP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	041712	MO
2	183500000X	Pharmacist	PH2190	DC
3	1835X0200X	Oncology Pharmacist	PH2190	DC

General Provider Information

NPI Number	:	1740340918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ANN WOLVERTON RPH, BCOP

Provider Business Mailing Address
First Line	:	110 IRVING STREET NW
Second Line	:	ROOM C1102
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-7858
Fax Number	:	202-877-4553

Provider Business Practice Location Address
First Line	:	110 IRVING STREET NW
Second Line	:	ROOM C1102
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-7858
Fax Number	:	202-877-4553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/11/2025

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