Provider Demographics
NPI:1689968935
Name:LAWRENCE, STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:LAWRENCE
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 1:2600 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3925
Mailing Address - Country:US
Mailing Address - Phone:615-382-9844
Mailing Address - Fax:
Practice Address - Street 1:2600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3925
Practice Address - Country:US
Practice Address - Phone:615-382-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5226183500000X
KY7308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist