Provider Demographics
NPI:1245875186
Name:VIGIL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VIGIL
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 1:621 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2604
Mailing Address - Country:US
Mailing Address - Phone:406-228-3693
Mailing Address - Fax:406-228-3694
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-3693
Practice Address - Fax:406-228-3694
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist