Provider Demographics
NPI:1578863643
Name:WEISSENBURGER, LAWRENCE JOHN JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:WEISSENBURGER
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2404
Mailing Address - Country:US
Mailing Address - Phone:707-585-5980
Mailing Address - Fax:707-585-5984
Practice Address - Street 1:6340 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2404
Practice Address - Country:US
Practice Address - Phone:707-585-5980
Practice Address - Fax:707-585-5984
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH30374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA449860OtherPHARMACY LICENSE NUMBER
CA7988233OtherMEDICAL NPI NO.
CA0556639OtherNADP
CA1255360277OtherNPI
CABS6897447OtherDEA