Provider Demographics
NPI:1033108386
Name:SCHWARTZWALD, LAURA J (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:SCHWARTZWALD
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 1:26235 RABBIT TRL
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-3172
Mailing Address - Country:US
Mailing Address - Phone:218-546-8209
Mailing Address - Fax:
Practice Address - Street 1:108 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3575
Practice Address - Country:US
Practice Address - Phone:218-829-0347
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115121-7183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist