Provider Demographics
NPI:1245518588
Name:FORD, LAURA LYNN (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:FORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 917
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-7117
Mailing Address - Country:US
Mailing Address - Phone:530-342-8892
Mailing Address - Fax:
Practice Address - Street 1:2100 DR MARTIN LUTHER KING JUNIOR PKWY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4422
Practice Address - Country:US
Practice Address - Phone:530-332-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49961183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist