Provider Demographics
NPI:1437751302
Name:SMITH, LAURA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 DOWNERS DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1329
Mailing Address - Country:US
Mailing Address - Phone:630-776-2249
Mailing Address - Fax:
Practice Address - Street 1:88 W GARTNER RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7563
Practice Address - Country:US
Practice Address - Phone:630-355-2500
Practice Address - Fax:630-355-9838
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist