Provider Demographics
NPI:1679108583
Name:LAWRENCE, JARED COLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:COLE
Last Name:LAWRENCE
Suffix:
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 1:8936 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2742
Mailing Address - Country:US
Mailing Address - Phone:952-881-0163
Mailing Address - Fax:
Practice Address - Street 1:8936 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2742
Practice Address - Country:US
Practice Address - Phone:952-881-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301535183500000X
MN124523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist