Provider Demographics
NPI:1235649716
Name:LAWRENCEVILLE COMMUNITY PHARMACY, INC
Entity Type:Organization
Organization Name:LAWRENCEVILLE COMMUNITY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREPHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-904-6668
Mailing Address - Street 1:3157 SUGARLOAF PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-9490
Mailing Address - Country:US
Mailing Address - Phone:919-904-6668
Mailing Address - Fax:
Practice Address - Street 1:3157 SUGARLOAF PKWY STE 103
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9490
Practice Address - Country:US
Practice Address - Phone:919-904-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy