Provider Demographics
NPI:1851635734
Name:HOUSTON, LAUREN KELLI (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KELLI
Last Name:HOUSTON
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:NAVAJO ROUTE 4, 2 MILES EAST OF PINON
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510
Mailing Address - Country:US
Mailing Address - Phone:928-725-9514
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO ROUTE 4, 2 MILES EAST OF PINON
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19817183500000X
DCPH100000845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist