Provider Demographics
NPI:1487780417
Name:LAFFIN, EMORY WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:EMORY
Middle Name:WAYNE
Last Name:LAFFIN
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 1:2709 KESTING CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2236
Mailing Address - Country:US
Mailing Address - Phone:920-735-0755
Mailing Address - Fax:
Practice Address - Street 1:800 E MAES AVE
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-1527
Practice Address - Country:US
Practice Address - Phone:920-788-9154
Practice Address - Fax:920-788-3255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7985-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist