Provider Demographics
NPI:1427371129
Name:ALLDREDGE, LAURIE BETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BETH
Last Name:ALLDREDGE
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 1:1918 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8020
Mailing Address - Country:US
Mailing Address - Phone:847-913-8978
Mailing Address - Fax:
Practice Address - Street 1:261 EAST TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-367-4652
Practice Address - Fax:847-367-1702
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist