Provider Demographics
NPI:1316269301
Name:SANCHEZ, LAURA J (RPH)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:101 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2224
Mailing Address - Country:US
Mailing Address - Phone:631-472-2138
Mailing Address - Fax:631-472-2138
Practice Address - Street 1:80 AIR PARK DR
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7360
Practice Address - Country:US
Practice Address - Phone:800-637-5633
Practice Address - Fax:800-982-8443
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist