Provider Demographics
NPI:1427254911
Name:LAVERDIERE, CARL B (RPH)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:B
Last Name:LAVERDIERE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARROWHEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766
Mailing Address - Country:US
Mailing Address - Phone:508-622-0213
Mailing Address - Fax:
Practice Address - Street 1:1933 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7131
Practice Address - Country:US
Practice Address - Phone:508-587-0235
Practice Address - Fax:508-584-0874
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist