Provider Demographics
NPI:1700569043
Name:GIFFORD, LAURA (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 S SANDPIPER DR APT 413
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4722
Mailing Address - Country:US
Mailing Address - Phone:801-971-2955
Mailing Address - Fax:
Practice Address - Street 1:99 W 1280 N
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9093
Practice Address - Country:US
Practice Address - Phone:435-882-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11921419-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist