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NPI 1114201324

NPI 1114201324 : LAURA BUCHANAN PHARMD : MOSCOW, ID

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General NPI Number Information
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    NPI Number           |    1114201324
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    Entity Type          |    Individual 
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    Provider Name        |    LAURA BUCHANAN PHARMD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    10/06/2011
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    Last Update Date     |    10/06/2011
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Provider Practice Location Address
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    Address Line         |    414 N MAIN ST 
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    City                 |    MOSCOW
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    State                |    ID
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    Zip                  |    83843-2631
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    Country              |    US
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    Telephone            |    208-882-6076
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    Fax                  |    208-882-6846
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Provider Business Mailing Address
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    Address Line         |    414 N MAIN ST 
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    City                 |    MOSCOW
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    State                |    ID
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    Zip                  |    83843-2631
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    Country              |    US
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    Telephone            |    208-882-6076
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    Fax                  |    208-882-6846
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    183500000X
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    Taxonomy Name        |    Pharmacist
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    License Number       |    P6402
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    License Number State |    ID
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Taxonomy #2
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    Taxonomy Code        |    183500000X
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    Taxonomy Name        |    Pharmacist
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    License Number       |    PH60148812
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    License Number State |    WA
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