Provider Demographics
NPI:1710469747
Name:GARDNER, LAWRENCE NIVEN (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:NIVEN
Last Name:GARDNER
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 1:442 TOILSOME HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1627
Mailing Address - Country:US
Mailing Address - Phone:203-336-5759
Mailing Address - Fax:203-929-5309
Practice Address - Street 1:875 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4621
Practice Address - Country:US
Practice Address - Phone:203-929-4597
Practice Address - Fax:203-929-5309
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist