Provider Demographics
NPI:1730629684
Name:BOOTS, LAURA
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:BOOTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 ROUTE 298
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6333 ROUTE 298
Practice Address - Street 2:SUITE 305
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-451-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062710183500000X
NYI062710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist