Provider Demographics
NPI:1972838613
Name:PERKINS, LAURA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:PERKINS
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 1:6920 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2461
Mailing Address - Country:US
Mailing Address - Phone:703-403-6269
Mailing Address - Fax:
Practice Address - Street 1:6920 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2461
Practice Address - Country:US
Practice Address - Phone:703-403-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209217183500000X
DCPHA2761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist