Provider Demographics
NPI:1194017442
Name:NUGENT, LAURA LYNN (CPHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:NUGENT
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 1:232B FROST RD
Mailing Address - Street 2:
Mailing Address - City:CADDO VALLEY
Mailing Address - State:AR
Mailing Address - Zip Code:71923-9609
Mailing Address - Country:US
Mailing Address - Phone:870-210-5162
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT87752183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
290100104072213OtherCERTIFIED PHARMACY TECHNICIAN
ARPT87752OtherPHARMACY TECHNICIAN REGISTRATION