Provider Demographics
NPI:1942694906
Name:VLAHOPOULOS, LAUREN MARIE
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MARIE
Last Name:VLAHOPOULOS
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 1:401 E ST HWY 260
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4932
Mailing Address - Country:US
Mailing Address - Phone:928-472-8242
Mailing Address - Fax:
Practice Address - Street 1:401 E ST HWY 260
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:928-472-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019105183500000X, 183500000X
IA21422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist