Provider Demographics
NPI:1275800849
Name:MEHOLICK, LAWRENCE NICHOLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:NICHOLAS
Last Name:MEHOLICK
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 1:1362 RANCHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1510
Mailing Address - Country:US
Mailing Address - Phone:440-449-4087
Mailing Address - Fax:
Practice Address - Street 1:5644 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2916
Practice Address - Country:US
Practice Address - Phone:440-646-2314
Practice Address - Fax:440-646-2551
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH . 03311904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRPH . 03311904OtherOHIO STATE BOARD OF PHARMACY LICENSE