Provider Demographics
NPI:1326452624
Name:HANSBURY, LAURA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HANSBURY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21001 N TATUM BLVD
Mailing Address - Street 2:SUITE 82
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:480-429-3921
Mailing Address - Fax:480-419-9042
Practice Address - Street 1:21001 N TATUM BLVD
Practice Address - Street 2:SUITE 82
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4206
Practice Address - Country:US
Practice Address - Phone:480-429-3921
Practice Address - Fax:480-419-9042
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS11705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist