Healthcare Provider Details

I. General information

NPI: 1194131664
Provider Name (Legal Business Name): LAURA EARLY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 07/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46977 ROMEO PLANK RD
MACOMB MI
48044-3509
US

IV. Provider business mailing address

46977 ROMEO PLANK RD
MACOMB MI
48044-3509
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-4285
  • Fax:
Mailing address:
  • Phone: 586-286-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041824
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: