Provider Demographics
NPI:1104462365
Name:SCHAEFER, LAURA SUSAN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUSAN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21595 NW SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-4282
Mailing Address - Country:US
Mailing Address - Phone:636-235-6447
Mailing Address - Fax:
Practice Address - Street 1:1 TROY SQ
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-3101
Practice Address - Country:US
Practice Address - Phone:636-528-8667
Practice Address - Fax:636-462-7010
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist