Provider Demographics
NPI:1902416746
Name:CORCORAN, LAWRENCE (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:CORCORAN
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 1:144 RED RD
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-3604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 W COLLIN ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452
Practice Address - Country:US
Practice Address - Phone:903-587-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist