Provider Demographics
NPI:1437548666
Name:LAUREL PHARMACY, LLC
Entity Type:Organization
Organization Name:LAUREL PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-428-7257
Mailing Address - Street 1:240 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4226
Mailing Address - Country:US
Mailing Address - Phone:601-428-7257
Mailing Address - Fax:
Practice Address - Street 1:240 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4226
Practice Address - Country:US
Practice Address - Phone:601-428-7257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-8087333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy