Provider Demographics
NPI:1639770811
Name:DROUIN, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DROUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOSSLER LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7128
Mailing Address - Country:US
Mailing Address - Phone:618-593-5772
Mailing Address - Fax:
Practice Address - Street 1:1511 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2537
Practice Address - Country:US
Practice Address - Phone:618-332-1133
Practice Address - Fax:618-332-1134
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist