Provider Demographics
NPI:1134909815
Name:MCDOUGALL, LAURA J
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16353 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8265
Mailing Address - Country:US
Mailing Address - Phone:979-690-6133
Mailing Address - Fax:
Practice Address - Street 1:725 E VILLA MARIA RD STE 1300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5320
Practice Address - Country:US
Practice Address - Phone:979-822-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43326183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician