Provider Demographics
NPI:1164878765
Name:HAFER, LAURA BROOKE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BROOKE
Last Name:HAFER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8972 UNITED LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3668
Mailing Address - Country:US
Mailing Address - Phone:740-594-3092
Mailing Address - Fax:740-593-5356
Practice Address - Street 1:8972 UNITED LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3668
Practice Address - Country:US
Practice Address - Phone:740-594-3092
Practice Address - Fax:740-593-5356
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390101070256852183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician