Provider Demographics
NPI:1760517957
Name:SMITH, JR, LAWRENCE ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALBERT
Last Name:SMITH, JR
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:LUMBER CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31549-0128
Mailing Address - Country:US
Mailing Address - Phone:912-363-4979
Mailing Address - Fax:912-363-8453
Practice Address - Street 1:LUMBER CITY DRUGS, INC
Practice Address - Street 2:HWY 341 SOUTH
Practice Address - City:LUMBER CITY
Practice Address - State:GA
Practice Address - Zip Code:31549-0128
Practice Address - Country:US
Practice Address - Phone:912-363-4979
Practice Address - Fax:912-363-8453
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist