Provider Demographics
NPI:1487359592
Name:BRODMANN, LAURA TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TAYLOR
Last Name:BRODMANN
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 1:107 DRUID RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3908
Mailing Address - Country:US
Mailing Address - Phone:912-224-5929
Mailing Address - Fax:
Practice Address - Street 1:1001 MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1220
Practice Address - Country:US
Practice Address - Phone:912-898-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0209391835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care