Provider Demographics
NPI:1063797405
Name:ANDERSON, LAURA KAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:580 KRISTI LYNNS WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4576
Mailing Address - Country:US
Mailing Address - Phone:706-577-2005
Mailing Address - Fax:
Practice Address - Street 1:2510 WYNNTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2184
Practice Address - Country:US
Practice Address - Phone:706-327-6181
Practice Address - Fax:706-327-7471
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist