Provider Demographics
NPI:1447846787
Name:OLIVER, LAURA B (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 WEDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8862
Mailing Address - Country:US
Mailing Address - Phone:317-514-3611
Mailing Address - Fax:
Practice Address - Street 1:11215 WEDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8862
Practice Address - Country:US
Practice Address - Phone:317-514-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018896A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist