Provider Demographics
NPI:1891001020
Name:GOLDMAN, LAURA LOUISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LOUISE
Last Name:GOLDMAN
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 1:5112 ESSEN LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-769-7224
Mailing Address - Fax:225-769-2303
Practice Address - Street 1:7777 HENNESSY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4363
Practice Address - Country:US
Practice Address - Phone:225-229-6769
Practice Address - Fax:225-765-1102
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist