Provider Demographics
NPI:1881136224
Name:LAURENZO, KAILE AMANDA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAILE
Middle Name:AMANDA
Last Name:LAURENZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4824
Mailing Address - Country:US
Mailing Address - Phone:843-248-6302
Mailing Address - Fax:
Practice Address - Street 1:707 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4824
Practice Address - Country:US
Practice Address - Phone:843-248-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36869183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear