Healthcare Provider Details

I. General information

NPI: 1891277216
Provider Name (Legal Business Name): LAURA STIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 09/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14806 WOODFOREST BLVD
CHANNELVIEW TX
77530
US

IV. Provider business mailing address

4434 CLAY ST APT 6
HOUSTON TX
77023
US

V. Phone/Fax

Practice location:
  • Phone: 281-457-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: