Provider Demographics
NPI:1003825308
Name:FOX, LAURA J (CPHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:FOX
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 N BECK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3377
Mailing Address - Country:US
Mailing Address - Phone:734-354-5950
Mailing Address - Fax:734-354-5992
Practice Address - Street 1:14300 N BECK RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3377
Practice Address - Country:US
Practice Address - Phone:734-354-5950
Practice Address - Fax:734-354-5992
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI221503062671699183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician