Provider Demographics
NPI:1134933864
Name:KOLLER, LAUREN JUSTINE MARY
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JUSTINE MARY
Last Name:KOLLER
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 1:7771 PALMETTO COMMERCE PKWY STE 404
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8860
Mailing Address - Country:US
Mailing Address - Phone:843-876-7074
Mailing Address - Fax:
Practice Address - Street 1:7771 PALMETTO COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8859
Practice Address - Country:US
Practice Address - Phone:843-876-7074
Practice Address - Fax:843-876-0226
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist