Provider Demographics
NPI:1841390515
Name:ENGELHARDT, LAURIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:ENGELHARDT
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 1:995 W GATES DR # 61-6
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2613
Mailing Address - Country:US
Mailing Address - Phone:435-725-2827
Mailing Address - Fax:435-722-3070
Practice Address - Street 1:505 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2929
Practice Address - Country:US
Practice Address - Phone:970-824-4449
Practice Address - Fax:970-824-8129
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT340672-1701183500000X
CO16008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist