Healthcare Provider Details

I. General information

NPI: 1528971371
Provider Name (Legal Business Name): LAURYN MILBOURNE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CAMPBELL BLVD
NOTTINGHAM MD
21236-5916
US

IV. Provider business mailing address

325 CARPENTER LN
PHILADELPHIA PA
19119-3004
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-7600
  • Fax:
Mailing address:
  • Phone: 215-779-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31217
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: