Provider Demographics
NPI:1164754149
Name:PEDLAR, LAURIE R (RPH)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:R
Last Name:PEDLAR
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 1:55 WETMORE AVE
Mailing Address - Street 2:APT 1L
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8208
Mailing Address - Country:US
Mailing Address - Phone:973-267-5535
Mailing Address - Fax:
Practice Address - Street 1:11A COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-3106
Practice Address - Country:US
Practice Address - Phone:800-526-5113
Practice Address - Fax:973-256-5346
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02793300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist