Provider Demographics
NPI:1508340977
Name:WILLOUGHBY, LAURA (RPH BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:RPH BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-5802
Mailing Address - Country:US
Mailing Address - Phone:270-756-2151
Mailing Address - Fax:270-756-5199
Practice Address - Street 1:675 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-5802
Practice Address - Country:US
Practice Address - Phone:270-756-2151
Practice Address - Fax:270-756-5199
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist