| NPI | 1396074282 |
|---|---|
| Former Name | LAURA A MICKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 43425) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 12853) |
| 183500000X Pharmacist (Licence: IA 20821) | |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |