Provider Demographics
NPI:1467734368
Name:LAWRENCE, PHILLIP TYLER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:TYLER
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 W MAUNA LOA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4752
Mailing Address - Country:US
Mailing Address - Phone:801-941-0580
Mailing Address - Fax:
Practice Address - Street 1:21025 N 8TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4101
Practice Address - Country:US
Practice Address - Phone:623-815-8965
Practice Address - Fax:623-815-1222
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist