Provider Demographics
NPI:1013060037
Name:LAWRENCE, THOMAS RUSSELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:LAWRENCE
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 1:104 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-1212
Mailing Address - Country:US
Mailing Address - Phone:859-289-5997
Mailing Address - Fax:
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-1154
Practice Address - Country:US
Practice Address - Phone:859-289-2528
Practice Address - Fax:859-289-2246
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist