Healthcare Provider Details

I. General information

NPI: 1629602586
Provider Name (Legal Business Name): LAURA K WHITED PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD UNIT 377
HOUSTON TX
77030-4000
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD UNIT 377
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 713-745-4566
  • Fax:
Mailing address:
  • Phone: 713-745-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number55460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: