Provider Demographics
NPI:1255636171
Name:TEMPLE, LAURA BETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BETH
Last Name:TEMPLE
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 1:605 NORTHWEST PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2915
Mailing Address - Country:US
Mailing Address - Phone:817-406-4546
Mailing Address - Fax:817-406-4550
Practice Address - Street 1:605 NORTHWEST PKWY STE 150
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2915
Practice Address - Country:US
Practice Address - Phone:817-406-4546
Practice Address - Fax:817-406-4550
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist