Provider Demographics
NPI:1942474390
Name:ALLEN, LAURA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:ALLEN
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 1:860 N VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-8502
Mailing Address - Country:US
Mailing Address - Phone:810-798-8501
Mailing Address - Fax:810-798-3303
Practice Address - Street 1:860 N VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8502
Practice Address - Country:US
Practice Address - Phone:810-798-8501
Practice Address - Fax:810-798-3303
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist