Provider Demographics
NPI:1316592314
Name:JOHANNING, LAURA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:JOHANNING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:HIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15602 VIKING ECLIPSE CT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7646
Mailing Address - Country:US
Mailing Address - Phone:812-664-2472
Mailing Address - Fax:
Practice Address - Street 1:1600 E 151ST ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5056
Practice Address - Country:US
Practice Address - Phone:317-564-3522
Practice Address - Fax:317-564-3523
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024180A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist