Provider Demographics
NPI:1134625171
Name:NELSON, LAURA ROBINSON
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROBINSON
Last Name:NELSON
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 1:2506 LAKELAND DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7656
Mailing Address - Country:US
Mailing Address - Phone:601-420-4041
Mailing Address - Fax:601-420-4040
Practice Address - Street 1:2506 LAKELAND DR STE 201
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7656
Practice Address - Country:US
Practice Address - Phone:601-420-4041
Practice Address - Fax:601-420-4040
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025869183500000X
FLPS46137183500000X
AL16449183500000X
MSE09182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist