Provider Demographics
NPI:1821122649
Name:DILLARD, LAURA LYNNE (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNNE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 LYLA AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4094
Mailing Address - Country:US
Mailing Address - Phone:704-786-5490
Mailing Address - Fax:704-786-2923
Practice Address - Street 1:30 WARREN C COLEMAN BLVD N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8318
Practice Address - Country:US
Practice Address - Phone:704-782-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist