Provider Demographics
NPI:1689276123
Name:FRANZ, LAURA RUTHERFORD (DPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTHERFORD
Last Name:FRANZ
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1554
Mailing Address - Country:US
Mailing Address - Phone:662-587-2470
Mailing Address - Fax:
Practice Address - Street 1:11100 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1554
Practice Address - Country:US
Practice Address - Phone:731-228-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist