Provider Demographics
NPI:1356326235
Name:SHONK, LAWRENCE DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DANIEL
Last Name:SHONK
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 1:1174 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3523
Mailing Address - Country:US
Mailing Address - Phone:614-294-4536
Mailing Address - Fax:614-488-0474
Practice Address - Street 1:2144 TREMONT CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3110
Practice Address - Country:US
Practice Address - Phone:614-488-2656
Practice Address - Fax:614-488-0474
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-08938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist