Provider Demographics
NPI:1083203160
Name:SCHUBERG, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SCHUBERG
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631-0515
Mailing Address - Country:US
Mailing Address - Phone:231-734-2551
Mailing Address - Fax:231-734-5890
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631-9416
Practice Address - Country:US
Practice Address - Phone:231-734-2551
Practice Address - Fax:231-734-5890
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315154701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist