Laura Elizabeth Broadhead, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PS51121 Issued in FL

Practice address

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Phone

(850) 863-7572

Fax

(850) 315-0523

NPI assigned

Jan 14, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389657600000",
    "number": "1962824789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7572",
            "fax_number": "850-315-0523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7572",
            "fax_number": "850-315-0523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADHEAD",
        "first_name": "LAURA",
        "middle_name": "ELIZABETH",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-14",
        "last_updated": "2014-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "FL",
            "license": "PS51121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgeway Center Inc
• Bridgeway Center, Inc
• Bridgeway Center, Inc
• Bridgeway Center, Inc
• Bridgeway Health Clinics, Inc.
• Melinda C Broadstone, O.T., M.T., CLT
• Bradley R Brobeck, MD
• Brittany Brock
• Riley Bromley, CSFA
• Ashley Brooks

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.