Provider Demographics
NPI:1275818346
Name:GOULET, LAWRENCE C (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:C
Last Name:GOULET
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 1:104 S APOPKA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4837
Mailing Address - Country:US
Mailing Address - Phone:352-344-8040
Mailing Address - Fax:
Practice Address - Street 1:104 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4837
Practice Address - Country:US
Practice Address - Phone:352-344-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist