Provider Demographics
NPI:1164609723
Name:SANFORD, LAWRENCE GARDNER
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:GARDNER
Last Name:SANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOOPER RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1560
Mailing Address - Country:US
Mailing Address - Phone:607-757-2638
Mailing Address - Fax:
Practice Address - Street 1:800 HOOPER RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1560
Practice Address - Country:US
Practice Address - Phone:607-757-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist