Provider Demographics
NPI:1619598166
Name:PATANE, LAURA BETHANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETHANY
Last Name:PATANE
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 1:1362 SOUZA DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7561
Mailing Address - Country:US
Mailing Address - Phone:707-301-7766
Mailing Address - Fax:
Practice Address - Street 1:4400 LATROBE RD
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-6704
Practice Address - Country:US
Practice Address - Phone:916-934-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist