Provider Demographics
NPI:1235473463
Name:REXROAD, LAURA DRAPER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DRAPER
Last Name:REXROAD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 WHISKEY RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-6183
Mailing Address - Country:US
Mailing Address - Phone:803-648-2339
Mailing Address - Fax:803-502-0971
Practice Address - Street 1:2062 WHISKEY RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6183
Practice Address - Country:US
Practice Address - Phone:803-648-2339
Practice Address - Fax:803-502-0971
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11873183500000X
GARPH024705183500000X
VA0202208983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist