Provider Demographics
NPI:1710594528
Name:JAMESON, LAURIE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANN
Last Name:JAMESON
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 1:873 S WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2723
Mailing Address - Country:US
Mailing Address - Phone:413-786-5955
Mailing Address - Fax:
Practice Address - Street 1:54 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3845
Practice Address - Country:US
Practice Address - Phone:860-741-2230
Practice Address - Fax:860-745-0474
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27527183500000X
CT0015070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27527OtherPHARMACIST LICENSE
CT0015070OtherPHARMACIST LICENSE