Provider Demographics
NPI:1639610231
Name:DAUGHARTY, LAURIE (RPH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DAUGHARTY
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 1:286 DERN DRAW
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7139
Mailing Address - Country:US
Mailing Address - Phone:406-250-9057
Mailing Address - Fax:
Practice Address - Street 1:286 DERN DRAW
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7139
Practice Address - Country:US
Practice Address - Phone:406-250-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist