Provider Demographics
NPI:1720237852
Name:YANCEY, LAURA M (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:YANCEY
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 1:3251 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2305
Mailing Address - Country:US
Mailing Address - Phone:770-920-1884
Mailing Address - Fax:770-920-2413
Practice Address - Street 1:3251 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2305
Practice Address - Country:US
Practice Address - Phone:770-920-1884
Practice Address - Fax:770-920-2413
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist