Provider Demographics
NPI:1033475991
Name:BENDER, LAWRENCE C III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:BENDER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEER RDG
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-8713
Mailing Address - Country:US
Mailing Address - Phone:601-545-9309
Mailing Address - Fax:
Practice Address - Street 1:4 DEER RDG
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-8713
Practice Address - Country:US
Practice Address - Phone:601-545-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09997183500000X
TX42362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist