Provider Demographics
NPI:1144907205
Name:WATERS, LAEKEN NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:LAEKEN
Middle Name:NICOLE
Last Name:WATERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 COUNTY ROAD 333
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-0357
Mailing Address - Country:US
Mailing Address - Phone:870-761-8335
Mailing Address - Fax:
Practice Address - Street 1:1911 W PARKER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8465
Practice Address - Country:US
Practice Address - Phone:870-972-1060
Practice Address - Fax:870-974-9022
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist