Provider Demographics
NPI:1992036578
Name:ABRAHAMSON, LAURA ANN LUTZ (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN LUTZ
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 MARKET ST NE
Mailing Address - Street 2:DISTRICT OFFICE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1826
Mailing Address - Country:US
Mailing Address - Phone:503-945-0816
Mailing Address - Fax:
Practice Address - Street 1:3740 MARKET ST NE
Practice Address - Street 2:DISTRICT OFFICE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1826
Practice Address - Country:US
Practice Address - Phone:503-945-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0011676183500000X
ORRPH-00116761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist