Provider Demographics
NPI:1164792529
Name:RADER, LAURA S (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:RADER
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:PO BOX 2258
Mailing Address - Street 2:106 N WESTERN AVE.
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2258
Mailing Address - Country:US
Mailing Address - Phone:509-663-2295
Mailing Address - Fax:509-665-4100
Practice Address - Street 1:1050 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1512
Practice Address - Country:US
Practice Address - Phone:509-663-2295
Practice Address - Fax:509-665-4100
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00013671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist