Provider Demographics
NPI:1497108104
Name:RAULERSON, LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RAULERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 TOM HILL SR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1816
Mailing Address - Country:US
Mailing Address - Phone:478-757-6526
Mailing Address - Fax:478-757-9163
Practice Address - Street 1:195 TOM HILL SR BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1816
Practice Address - Country:US
Practice Address - Phone:478-757-6526
Practice Address - Fax:478-757-9163
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist