Provider Demographics
NPI:1245458348
Name:LEBOVITZ, LAURENCE M (RPH)
Entity type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:M
Last Name:LEBOVITZ
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 1:15669 N 111TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8874
Mailing Address - Country:US
Mailing Address - Phone:480-353-0882
Mailing Address - Fax:
Practice Address - Street 1:15669 N 111TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8874
Practice Address - Country:US
Practice Address - Phone:480-353-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist