Healthcare Provider Details

I. General information

NPI: 1831505437
Provider Name (Legal Business Name): LAURA GOLD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10078 E PERSHING AVE
SCOTTSDALE AZ
85260-7221
US

IV. Provider business mailing address

5900 N GRANITE REEF RD STE 102
SCOTTSDALE AZ
85250-6280
US

V. Phone/Fax

Practice location:
  • Phone: 602-703-7275
  • Fax:
Mailing address:
  • Phone: 602-703-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011855
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number011855
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number011855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: