Provider Demographics
NPI:1114559473
Name:ANDERSON, LAURIE A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:ANDERSON
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 1:22580 FORRESTER LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-6331
Mailing Address - Country:US
Mailing Address - Phone:402-699-7855
Mailing Address - Fax:712-623-2839
Practice Address - Street 1:1605 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1027
Practice Address - Country:US
Practice Address - Phone:712-623-3370
Practice Address - Fax:712-623-2839
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist