Provider Demographics
NPI:1578163358
Name:RILLMAN, LAURA PARKER (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:PARKER
Last Name:RILLMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CONIFER SQ
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4542
Mailing Address - Country:US
Mailing Address - Phone:864-838-3289
Mailing Address - Fax:
Practice Address - Street 1:596 BOBBY JONES EXPY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5300
Practice Address - Country:US
Practice Address - Phone:706-863-9693
Practice Address - Fax:706-863-9722
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12101183500000X
GARPH029513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist