Provider Demographics
NPI:1477833952
Name:SORENSEN, LAUREL (RPH)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:SORENSEN
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 1:2254 GRANITE CIR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3039
Mailing Address - Country:US
Mailing Address - Phone:507-993-6667
Mailing Address - Fax:
Practice Address - Street 1:80 14TH ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3810
Practice Address - Country:US
Practice Address - Phone:507-206-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115891183500000X
CO14219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist