Provider Demographics
NPI:1699409607
Name:FANKEP, LAURENCE BRIGITTE
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:BRIGITTE
Last Name:FANKEP
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 1:4324 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-1900
Mailing Address - Country:US
Mailing Address - Phone:774-232-6101
Mailing Address - Fax:
Practice Address - Street 1:9937 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3259
Practice Address - Country:US
Practice Address - Phone:214-328-6958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist