Provider Demographics
NPI:1710311766
Name:WINDHAM, LAURIE COOK (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:COOK
Last Name:WINDHAM
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 1:1204 JACKSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1732
Mailing Address - Country:US
Mailing Address - Phone:334-389-0016
Mailing Address - Fax:
Practice Address - Street 1:1850 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5960
Practice Address - Country:US
Practice Address - Phone:678-583-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist