Provider Demographics
NPI:1093890121
Name:GOULD, LAURA ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:GOULD
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 1:801 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2142
Mailing Address - Country:US
Mailing Address - Phone:850-747-6018
Mailing Address - Fax:850-747-6717
Practice Address - Street 1:801 E 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3662
Practice Address - Country:US
Practice Address - Phone:850-747-6018
Practice Address - Fax:850-747-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS20630OtherFLORIDA PHARMACY LICENSE