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General NPI Number Information
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NPI Number | 1437548666
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Entity Type | Organization
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Legal Business Name | LAUREL PHARMACY, LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 240 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4226
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Country | US
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Telephone | 601-428-7257
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S 13TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4226
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Country | US
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Telephone | 601-428-7257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY CHATHAM
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Credential |
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Telephone | 601-428-7257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | E-8087
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License Number State | MS
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