Provider Demographics
NPI:1063016301
Name:MUSA, LAUREN
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:MUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 W ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1121
Mailing Address - Country:US
Mailing Address - Phone:937-298-5512
Mailing Address - Fax:
Practice Address - Street 1:2657 W ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45459-1121
Practice Address - Country:US
Practice Address - Phone:937-298-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist