Provider Demographics
NPI:1972843951
Name:RAPP, LAINE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:ELIZABETH
Last Name:RAPP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAINE
Other - Middle Name:ELIZABETH
Other - Last Name:PAUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11481 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7184
Mailing Address - Country:US
Mailing Address - Phone:314-432-5708
Mailing Address - Fax:
Practice Address - Street 1:11481 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7184
Practice Address - Country:US
Practice Address - Phone:314-432-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026226183500000X
IL051.296206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist