Provider Demographics
NPI:1053634246
Name:FORD, LAUREN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FONDA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2707
Mailing Address - Country:US
Mailing Address - Phone:516-766-1519
Mailing Address - Fax:516-887-3689
Practice Address - Street 1:1155 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3105
Practice Address - Country:US
Practice Address - Phone:631-667-5030
Practice Address - Fax:631-667-0766
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035968-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist