Healthcare Provider Details

I. General information

NPI: 1578685970
Provider Name (Legal Business Name): MICHAEL JOSEPH LAUBACH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROAD ST
STORY CITY IA
50248-1200
US

IV. Provider business mailing address

1122 BURNETT AVE
AMES IA
50010-5766
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-2252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19149
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: