Provider Demographics
NPI:1245622208
Name:BEALL, LAURA MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:BEALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-1411
Mailing Address - Country:US
Mailing Address - Phone:903-825-1106
Mailing Address - Fax:
Practice Address - Street 1:1600 W SOUTHWEST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8532
Practice Address - Country:US
Practice Address - Phone:903-877-6855
Practice Address - Fax:903-582-6870
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist