Provider Demographics
NPI:1942597943
Name:O'DANIEL, LAURIE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:O'DANIEL
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 1:18255 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4585
Mailing Address - Country:US
Mailing Address - Phone:210-764-7972
Mailing Address - Fax:210-764-7972
Practice Address - Street 1:18255 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4585
Practice Address - Country:US
Practice Address - Phone:210-764-7972
Practice Address - Fax:210-764-7972
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist