Provider Demographics
NPI:1659582633
Name:BELGRADE, LAWRENCE EARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:EARL
Last Name:BELGRADE
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 1:844 INTERLAKEN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1338
Mailing Address - Country:US
Mailing Address - Phone:847-438-7927
Mailing Address - Fax:847-438-7928
Practice Address - Street 1:844 INTERLAKEN DR
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1338
Practice Address - Country:US
Practice Address - Phone:847-438-7927
Practice Address - Fax:847-438-7928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist