Healthcare Provider Details

I. General information

NPI: 1942616263
Provider Name (Legal Business Name): LAUREN GLAZE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN GLAZE PHARM.D.

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W GROVE ST STE 202
EL DORADO AR
71730-4425
US

IV. Provider business mailing address

620 W GROVE ST STE 202
EL DORADO AR
71730-4425
US

V. Phone/Fax

Practice location:
  • Phone: 870-639-9939
  • Fax: 870-639-9914
Mailing address:
  • Phone: 870-639-9939
  • Fax: 870-639-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12864
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: