Provider Demographics
NPI:1811591258
Name:FORD, LAUREN A
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:FORD
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 1:9611 ROARKS PSGE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6231
Mailing Address - Country:US
Mailing Address - Phone:832-715-9838
Mailing Address - Fax:
Practice Address - Street 1:104 W SEALY ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2339
Practice Address - Country:US
Practice Address - Phone:281-968-7946
Practice Address - Fax:281-968-7541
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist