Provider Demographics
NPI:1154504116
Name:LAWRENCE, CARL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PALMER AVE.
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822
Mailing Address - Country:US
Mailing Address - Phone:518-654-7464
Mailing Address - Fax:
Practice Address - Street 1:1 PALMER AVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1121
Practice Address - Country:US
Practice Address - Phone:518-654-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24395-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist