Provider Demographics
NPI:1083826556
Name:RIDER, LAURA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELIZABETH
Last Name:RIDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7002 BITTERROOT DR.
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586
Mailing Address - Country:US
Mailing Address - Phone:815-254-5457
Mailing Address - Fax:630-986-8468
Practice Address - Street 1:50 E. OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:630-986-8065
Practice Address - Fax:630-986-8468
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist