Provider Demographics
NPI:1750025581
Name:DAUGHERTY, LAUREN RUTH (DPH)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:RUTH
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-0098
Mailing Address - Country:US
Mailing Address - Phone:580-650-9004
Mailing Address - Fax:
Practice Address - Street 1:85 S MIDDLETON RD STE 150
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1526
Practice Address - Country:US
Practice Address - Phone:208-505-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP11244183500000X
OK14885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist