Provider Demographics
NPI:1538286877
Name:WASSER, LAUREL B (RPH)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:B
Last Name:WASSER
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 1:635 DUTCHESS TPKE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1920
Mailing Address - Country:US
Mailing Address - Phone:845-471-6130
Mailing Address - Fax:845-473-5564
Practice Address - Street 1:635 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1920
Practice Address - Country:US
Practice Address - Phone:845-471-6130
Practice Address - Fax:845-473-5564
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist