Provider Demographics
NPI:1558396036
Name:SQUIRES, LAURA SUE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SUE
Last Name:SQUIRES
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 1:422 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-2908
Mailing Address - Country:US
Mailing Address - Phone:785-632-3115
Mailing Address - Fax:785-632-3777
Practice Address - Street 1:422 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-2908
Practice Address - Country:US
Practice Address - Phone:785-632-3115
Practice Address - Fax:785-632-3777
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist