Provider Demographics
NPI:1942638705
Name:LAWRENCE, HAROLD RAY (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:RAY
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17643 US HIGHWAY 136 W
Mailing Address - Street 2:
Mailing Address - City:ROCK PORT
Mailing Address - State:MO
Mailing Address - Zip Code:64482-9477
Mailing Address - Country:US
Mailing Address - Phone:660-744-3411
Mailing Address - Fax:
Practice Address - Street 1:1301 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2228
Practice Address - Country:US
Practice Address - Phone:816-901-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20948183500000X
NE13087183500000X
MO042303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist