Provider Demographics
NPI:1457672842
Name:WYCOFF, LAUREL JANELLE (CPHT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:JANELLE
Last Name:WYCOFF
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24123 PEACHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3774
Mailing Address - Country:US
Mailing Address - Phone:941-627-5704
Mailing Address - Fax:941-625-1986
Practice Address - Street 1:24123 PEACHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3774
Practice Address - Country:US
Practice Address - Phone:941-627-5704
Practice Address - Fax:941-625-1986
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT2291183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician