Provider Demographics
NPI:1104108224
Name:WEBER, LAURA J (PHARMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:WEBER
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 1:1046 LINCOLN AVE NW
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-8324
Mailing Address - Country:US
Mailing Address - Phone:580-603-2402
Mailing Address - Fax:
Practice Address - Street 1:1046 LINCOLN AVE NW
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8034
Practice Address - Country:US
Practice Address - Phone:580-603-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist