Healthcare Provider Details

I. General information

NPI: 1104821685
Provider Name (Legal Business Name): LAUREN C DUTY PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

615 LAKE HARDING DR
HAMILTON GA
31811-4353
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1495
  • Fax: 706-571-1861
Mailing address:
  • Phone: 706-596-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number017388
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: