Provider Demographics
NPI:1093006926
Name:CRUZ, LAURA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 HURSTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1175
Mailing Address - Country:US
Mailing Address - Phone:801-965-8084
Mailing Address - Fax:
Practice Address - Street 1:828 S 900 W
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84104-1455
Practice Address - Country:US
Practice Address - Phone:801-364-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5663779-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist