=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700281391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA DALHOVER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2014
-----------------------------------------------------
Last Update Date | 10/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6767 US HIGHWAY 98 N
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33809-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-859-5838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5010 SMOKE RISE TRL APT 201
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33805-2370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-255-4498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS52734
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------