Provider Demographics
NPI:1114041100
Name:ALLEN, LAURA LEA (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:ALLEN
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 1:308 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1733
Mailing Address - Country:US
Mailing Address - Phone:620-431-1357
Mailing Address - Fax:620-431-1357
Practice Address - Street 1:205 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3323
Practice Address - Country:US
Practice Address - Phone:620-331-4200
Practice Address - Fax:620-331-8220
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist