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General NPI Number Information
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NPI Number | 1174262752
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Entity Type | Individual
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Provider Name | LAURIE ANN HENEGAR PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 07/09/2022
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Provider Practice Location Address
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Address Line | 275 N TEGNER ST
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City | WICKENBURG
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State | AZ
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Zip | 85390-2415
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Country | US
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Telephone | 928-684-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 4765 W LUPINE AVE
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City | GLENDALE
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State | AZ
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Zip | 85304-2811
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Country | US
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Telephone | 602-334-8094
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Fax |
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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 | S016933
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License Number State | AZ
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