Provider Demographics
NPI:1629671938
Name:MCALLISTER, LAURA LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:MCALLISTER
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:POB 6762
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702
Mailing Address - Country:US
Mailing Address - Phone:802-558-2949
Mailing Address - Fax:
Practice Address - Street 1:82 NEWPORT ROAD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:802-558-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR24931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHR2493OtherR2493
VT033-0003789Other033-0003789
MAPH27336OtherPH27336