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General NPI Number Information
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NPI Number | 1144570888
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Entity Type | Individual
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Provider Name | LAURA GORE
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Gender | Female
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 2492 HWY 9 EAST
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City | LITTLE RIVER
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State | SC
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Zip | 29566
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Country | US
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Telephone | 843-399-1726
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Fax | 843-399-8497
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Provider Business Mailing Address
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Address Line | 5425 MILLER RD
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City | TABOR CITY
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State | NC
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Zip | 28463
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Country | US
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Telephone | 843-457-1556
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Fax | 843-399-8497
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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 | 7703
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License Number State | SC
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