Provider Demographics
NPI:1619000452
Name:KLEBOSKY, LAURIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LYNN
Last Name:KLEBOSKY
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 1:5426 SWEETGALE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7685
Mailing Address - Country:US
Mailing Address - Phone:678-714-7207
Mailing Address - Fax:
Practice Address - Street 1:605 GRAYSON HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6333
Practice Address - Country:US
Practice Address - Phone:770-963-6653
Practice Address - Fax:770-338-7563
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist