Provider Demographics
NPI:1235340209
Name:ANNIS, LAURA G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:G
Last Name:ANNIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 TWIN CREEKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-9201
Mailing Address - Country:US
Mailing Address - Phone:813-651-0232
Mailing Address - Fax:
Practice Address - Street 1:5109 W LEMON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1105
Practice Address - Country:US
Practice Address - Phone:813-769-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist