Provider Demographics
NPI:1396074282
Name:ANDERSON, LAURA A (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:MICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:12601 TECH RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-3451
Mailing Address - Country:US
Mailing Address - Phone:512-491-6051
Mailing Address - Fax:512-491-7749
Practice Address - Street 1:12601 TECH RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3451
Practice Address - Country:US
Practice Address - Phone:512-491-6051
Practice Address - Fax:512-491-7749
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43425183500000X
NE12853183500000X
IA20821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist