Provider Demographics
NPI:1255778825
Name:PELOQUIN, LAURA J (RPH, PHARM D)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 SOPPE FARM RD
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:IA
Mailing Address - Zip Code:50702-6003
Mailing Address - Country:US
Mailing Address - Phone:319-235-3172
Mailing Address - Fax:319-235-3408
Practice Address - Street 1:1825 LOGAN AVE RM 551
Practice Address - Street 2:ALLEN HOSPITAL ANTICOAGULATION CLINIC
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3172
Practice Address - Fax:319-235-3408
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17284183500000X
MN115318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist