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NPI Code Detail

MEDICARE: LAURA OUTLAW PHARMD

MEDICARE: LAURA OUTLAW PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist35518SC

General Provider Information

NPI Number : 1306254917
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA OUTLAW PHARMD
Provider Business Mailing Address
First Line : 1008 LAKE MURRAY BLVD
Second Line :
City : IRMO
State : SC
Zip : 29063-2821
Country : US
Telephone Number : 803-749-3843
Fax Number :
Provider Business Practice Location Address
First Line : 1008 LAKE MURRAY BLVD
Second Line :
City : IRMO
State : SC
Zip : 29063-2821
Country : US
Telephone Number : 803-749-3843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2014
Last Update Date : 07/27/2014

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Directions to “ LAURA OUTLAW PHARMD” Practice Location

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