Provider Demographics
NPI:1881965820
Name:DALY, LAUREL A (RPH)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:A
Last Name:DALY
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 1:36 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-3759
Mailing Address - Country:US
Mailing Address - Phone:781-899-9050
Mailing Address - Fax:
Practice Address - Street 1:71 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1107
Practice Address - Country:US
Practice Address - Phone:781-622-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist