Laurel Ip

Key facts

NPI

1851921092

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RPH029455 (GA)

Practice address

3455 Peachtree Industrial Blvd
Duluth, GA 30096-6501

Phone

(770) 476-7985

NPI assigned

Jan 15, 2020

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 15, 2020.

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1851921092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE INDUSTRIAL BLVD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 PEACHTREE INDUSTRIAL BLVD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966501",
            "telephone_number": "770-476-7985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IP",
        "first_name": "LAUREL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH029455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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