Healthcare Provider Details

I. General information

NPI: 1225486434
Provider Name (Legal Business Name): LAURA BEARDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S FAIR OAKS AVE SUITE 200
PASADENA CA
91105-4130
US

IV. Provider business mailing address

257 S FAIR OAKS AVE SUITE 200
PASADENA CA
91105-4130
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-0099
  • Fax: 626-449-7388
Mailing address:
  • Phone: 626-449-0099
  • Fax: 626-449-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44188
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number122703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: