Basic Information
| Provider Information | |||||||||
| NPI: | 1811234776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | PHELPS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2033 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043811162 | ||||||||
| FaxNumber: | 9043818673 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 MARKETSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320810574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048251913 | ||||||||
| FaxNumber: | 9048256768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2013 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS44872 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.