Provider Demographics
NPI:1013011063
Name:LAURELPHARM LLC
Entity Type:Organization
Organization Name:LAURELPHARM LLC
Other - Org Name:IN HOUSE PHCY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRES
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:440 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3726
Practice Address - Country:US
Practice Address - Phone:850-785-2104
Practice Address - Fax:800-882-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH19549333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1094781OtherOTHER ID NUMBER-COMMERCIAL NUMBER