Provider Demographics
NPI:1356691984
Name:STOUT, LAUREN APRIL (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:APRIL
Last Name:STOUT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 NOAH SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-5531
Mailing Address - Country:US
Mailing Address - Phone:423-895-1234
Mailing Address - Fax:
Practice Address - Street 1:129 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1307
Practice Address - Country:US
Practice Address - Phone:423-727-6501
Practice Address - Fax:423-727-9500
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist