Provider Demographics
NPI:1821143215
Name:LAWRENCE, HOMER DUANE (PD)
Entity Type:Individual
Prefix:MR
First Name:HOMER
Middle Name:DUANE
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:MR
Other - First Name:DUANE
Other - Middle Name:
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2107 VANCE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7752
Mailing Address - Country:US
Mailing Address - Phone:405-341-1680
Mailing Address - Fax:405-341-8496
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-341-8490
Practice Address - Fax:405-341-8496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist