Provider Demographics
NPI:1780203679
Name:MCMAHON, LAURA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BROUGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1482
Practice Address - Country:US
Practice Address - Phone:859-218-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist