Provider Demographics
NPI:1861776767
Name:WALTERS, LAURA ANNE (PHARM D RPH)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PHARM D RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 LABURNUM RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-1655
Mailing Address - Country:US
Mailing Address - Phone:847-963-1187
Mailing Address - Fax:
Practice Address - Street 1:189 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3107
Practice Address - Country:US
Practice Address - Phone:847-381-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051041094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist