Provider Demographics
NPI:1649564832
Name:WINBERRY, LAWRENCE III
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:WINBERRY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 E COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7018
Mailing Address - Country:US
Mailing Address - Phone:480-231-1895
Mailing Address - Fax:
Practice Address - Street 1:3931 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2004
Practice Address - Country:US
Practice Address - Phone:480-281-0202
Practice Address - Fax:480-281-0202
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist