Provider Demographics
NPI:1134372378
Name:SINDELAR, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SINDELAR
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 1:8822 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-6416
Mailing Address - Country:US
Mailing Address - Phone:269-327-3049
Mailing Address - Fax:
Practice Address - Street 1:8822 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-6416
Practice Address - Country:US
Practice Address - Phone:269-327-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024797OtherBOARD OF PHARMACY REGISTERED PHARMACIST LICENSE