=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659956050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA WESTPHAL RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2021
-----------------------------------------------------
Last Update Date | 03/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 189 ALPS RD
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-4771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-315-2634
-----------------------------------------------------
Fax | 203-315-2154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 ALPS RD
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405-4771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-315-2634
-----------------------------------------------------
Fax | 203-315-2154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8117
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------