Provider Demographics
NPI:1073806402
Name:SMITH, LAWRENCE MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
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 1:2851 HENLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7204
Mailing Address - Country:US
Mailing Address - Phone:904-744-8425
Mailing Address - Fax:
Practice Address - Street 1:2851 HENLEY RD
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-7204
Practice Address - Country:US
Practice Address - Phone:904-899-6902
Practice Address - Fax:904-291-3288
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist