Provider Demographics
NPI:1770714511
Name:MEANY, LAURA DICKEY (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DICKEY
Last Name:MEANY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RUTH
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2208 OAKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5892
Mailing Address - Country:US
Mailing Address - Phone:615-962-9970
Mailing Address - Fax:
Practice Address - Street 1:5171 SAM JARED DR BLDG 112
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1382
Practice Address - Country:US
Practice Address - Phone:615-904-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33534183500000X
AL12276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist