Individual
MR. LAURENCE EVAN NISONOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
105 EDWARDS VILLAGE BLVD STE G-107, EDWARDS, CO 81632-9914
(970) 476-7308
Mailing address
1418 MORAINE DR, VAIL, CO 81657-4981
(970) 476-7308
(970) 476-7306
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13767
CO
Other
Enumeration date
07/27/2011
Last updated
07/27/2011
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