Provider Demographics
NPI:1083020507
Name:JEFFCOAT, LAURA NICHOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:NICHOLE
Last Name:JEFFCOAT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1257
Mailing Address - Country:US
Mailing Address - Phone:803-256-7481
Mailing Address - Fax:
Practice Address - Street 1:2801 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1257
Practice Address - Country:US
Practice Address - Phone:803-256-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist