Healthcare Provider Details

I. General information

NPI: 1588579742
Provider Name (Legal Business Name): LAURA PHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PLEASANT VALLEY ST
METHUEN MA
01844-7288
US

IV. Provider business mailing address

70 PLEASANT VALLEY ST
METHUEN MA
01844-7288
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-2633
  • Fax:
Mailing address:
  • Phone: 978-686-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1003732
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: