Provider Demographics
NPI:1629352471
Name:KARGACIN, LAURA (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KARGACIN
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 1:4535 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:BYRNES MILL
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2042
Mailing Address - Country:US
Mailing Address - Phone:636-375-3656
Mailing Address - Fax:636-375-3647
Practice Address - Street 1:4535 HUNTER LN
Practice Address - Street 2:
Practice Address - City:BYRNES MILL
Practice Address - State:MO
Practice Address - Zip Code:63051-2042
Practice Address - Country:US
Practice Address - Phone:636-375-3656
Practice Address - Fax:636-375-3647
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist