Provider Demographics
NPI:1740388784
Name:LAWRENCE HYDE CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE HYDE CORPORATION
Other - Org Name:LAWRENCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-487-3458
Mailing Address - Street 1:1156 GEORGE WASHINGTON HWY N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4908
Mailing Address - Country:US
Mailing Address - Phone:757-487-3458
Mailing Address - Fax:757-487-4131
Practice Address - Street 1:1156 GEORGE WASHINGTON HWY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-4908
Practice Address - Country:US
Practice Address - Phone:757-487-3458
Practice Address - Fax:757-487-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
VA02010004163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8504130Medicaid
2102423OtherPK
VA1740388784Medicaid
VA1740388784Medicaid