Provider Demographics
NPI:1063638013
Name:JUSTICE, LAWRENCE C JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:C
Last Name:JUSTICE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:3048 LINDHOLM ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-2614
Mailing Address - Country:US
Mailing Address - Phone:318-813-1815
Mailing Address - Fax:318-813-1811
Practice Address - Street 1:1606 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130-4128
Practice Address - Country:US
Practice Address - Phone:318-813-1815
Practice Address - Fax:318-813-1811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA14448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2161733Medicaid
MA.001644OtherMEDICATION ADMINISTRATION