Provider Demographics
NPI:1790025864
Name:TREMBATH, LAURA MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:TREMBATH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1003
Mailing Address - Country:US
Mailing Address - Phone:727-417-7230
Mailing Address - Fax:
Practice Address - Street 1:120 CARILLON PKWY
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1201
Practice Address - Country:US
Practice Address - Phone:727-540-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist