Provider Demographics
NPI:1417234212
Name:HAROLDSON, LAUREL ANN (R PH)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ANN
Last Name:HAROLDSON
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3165
Mailing Address - Country:US
Mailing Address - Phone:701-252-3181
Mailing Address - Fax:701-252-0906
Practice Address - Street 1:213 1ST AVE N
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3165
Practice Address - Country:US
Practice Address - Phone:701-252-3181
Practice Address - Fax:701-252-0906
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3392OtherPHARMACIST LICENSE NUMBER