Provider Demographics
NPI:1942831896
Name:MCNAY, LAURA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:MCNAY
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 1:18756 VANDERHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1417
Mailing Address - Country:US
Mailing Address - Phone:734-718-5059
Mailing Address - Fax:
Practice Address - Street 1:25380 5 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3740
Practice Address - Country:US
Practice Address - Phone:313-592-6357
Practice Address - Fax:313-592-1229
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist