Provider Demographics
NPI:1386138436
Name:COUTCHER, LAURA MASSENA-MAZUR
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MASSENA-MAZUR
Last Name:COUTCHER
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 1:342 HARTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4204
Mailing Address - Country:US
Mailing Address - Phone:540-538-8528
Mailing Address - Fax:
Practice Address - Street 1:1505 STAFFORD MARKET PL
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556
Practice Address - Country:US
Practice Address - Phone:540-288-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist