Provider Demographics
NPI:1508168261
Name:BERGSIEKER, LAURA BETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:BERGSIEKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 DR MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-7845
Mailing Address - Country:US
Mailing Address - Phone:615-890-5911
Mailing Address - Fax:615-890-5089
Practice Address - Street 1:1131 DR MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-7845
Practice Address - Country:US
Practice Address - Phone:615-890-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist