Provider Demographics
NPI:1649680075
Name:HISCOCK, LAURA (PHARMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HISCOCK
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 1:606 S GREENVILLE WEST DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-3513
Mailing Address - Country:US
Mailing Address - Phone:616-754-2433
Mailing Address - Fax:616-225-7765
Practice Address - Street 1:606 S GREENVILLE WEST DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3513
Practice Address - Country:US
Practice Address - Phone:616-754-2433
Practice Address - Fax:616-225-7765
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020324871835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy