Healthcare Provider Details

I. General information

NPI: 1578674693
Provider Name (Legal Business Name): LAURA NEED LORD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR ROC RM 1201
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

8501 S MERIDIAN ST
INDIANAPOLIS IN
46217-5023
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2335
  • Fax: 317-278-0792
Mailing address:
  • Phone: 317-882-0098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016980
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: