Healthcare Provider Details

I. General information

NPI: 1104853407
Provider Name (Legal Business Name): LAURA LEA PINCOCK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 7TH ST
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

27109 FAMILY TER
DAMASCUS MD
20872-1006
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3393
  • Fax: 240-566-3395
Mailing address:
  • Phone: 301-391-6656
  • Fax: 301-796-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14416
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number14416
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14416
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: