Provider Demographics
NPI:1386401966
Name:FLETCHER, LAUREN (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FLETCHER
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 1:22809 E COUNTRY VISTA DR APT 37
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7540
Mailing Address - Country:US
Mailing Address - Phone:315-571-8631
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 228
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4473
Practice Address - Country:US
Practice Address - Phone:208-625-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist