Provider Demographics
NPI:1881042182
Name:SEIFERT, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SEIFERT
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 1:27 WOOD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1092
Mailing Address - Country:US
Mailing Address - Phone:847-428-6743
Mailing Address - Fax:
Practice Address - Street 1:1489 PALATINE RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1196
Practice Address - Country:US
Practice Address - Phone:847-202-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051041073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist