Provider Demographics
NPI:1558074781
Name:KURTH, LAKEN ALYSS-MITCHELL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:ALYSS-MITCHELL
Last Name:KURTH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NEWLANDS DR E
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-8910
Mailing Address - Country:US
Mailing Address - Phone:775-575-6198
Mailing Address - Fax:
Practice Address - Street 1:1550 NEWLANDS DR E
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-8910
Practice Address - Country:US
Practice Address - Phone:775-575-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist