Provider Demographics
NPI:1508149618
Name:BLEVINS, LAURA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:ESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:405 E NIFONG BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3708
Mailing Address - Country:US
Mailing Address - Phone:573-442-8616
Mailing Address - Fax:573-442-8652
Practice Address - Street 1:405 E NIFONG BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3708
Practice Address - Country:US
Practice Address - Phone:573-442-8616
Practice Address - Fax:573-442-8652
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010019715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist