Provider Demographics
NPI:1902968738
Name:SPEIDEL, LAURA J (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:SPEIDEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LAMP POST DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5809
Mailing Address - Country:US
Mailing Address - Phone:585-426-3957
Mailing Address - Fax:585-426-3957
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3928
Practice Address - Fax:585-368-3929
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043053183500000X
MA22992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist