Healthcare Provider Details

I. General information

NPI: 1619384997
Provider Name (Legal Business Name): LAURA ANN PUCCETTI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANN HARRIS PHARM.D.

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 E. TERRACE DR.
MADISON WI
53718-8339
US

IV. Provider business mailing address

5249 E TERRACE DR.
MADISON WI
53718-8339
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-1292
  • Fax:
Mailing address:
  • Phone: 608-263-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17450-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: