Provider Demographics
NPI:1346522638
Name:HITCHCOCK, LAURA LEE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:HITCHCOCK
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 1:1800 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-428-1558
Mailing Address - Fax:386-428-2668
Practice Address - Street 1:1800 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8341
Practice Address - Country:US
Practice Address - Phone:386-428-1558
Practice Address - Fax:386-428-2668
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist