Provider Demographics
NPI:1255867677
Name:MARTIN, LAURA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MARTIN
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 1:42 TOWN ST
Mailing Address - Street 2:STOP & SHOP PHARMACY
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2316
Mailing Address - Country:US
Mailing Address - Phone:860-887-1615
Mailing Address - Fax:
Practice Address - Street 1:42 TOWN ST
Practice Address - Street 2:STOP & SHOP PHARMACY
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2316
Practice Address - Country:US
Practice Address - Phone:860-887-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist