Provider Demographics
NPI:1477786762
Name:WEINER, LAWRENCE ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:WEINER
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 1:14 FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2312
Mailing Address - Country:US
Mailing Address - Phone:516-622-6354
Mailing Address - Fax:
Practice Address - Street 1:14 FLOWER LANE
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2312
Practice Address - Country:US
Practice Address - Phone:516-622-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist