Provider Demographics
NPI:1699075598
Name:LAUTENSCHLAGER, GABRIEL CARVER (PHARM D)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:CARVER
Last Name:LAUTENSCHLAGER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4801
Mailing Address - Country:US
Mailing Address - Phone:509-764-4721
Mailing Address - Fax:509-764-7412
Practice Address - Street 1:601 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4801
Practice Address - Country:US
Practice Address - Phone:509-764-4721
Practice Address - Fax:509-764-7412
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5290183500000X
WAPH60149356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist