Provider Demographics
NPI:1841631249
Name:RUSH, LAWRENCE C JR (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:C
Last Name:RUSH
Suffix:JR
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 1:9410 SW 35TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8614
Mailing Address - Country:US
Mailing Address - Phone:954-801-2129
Mailing Address - Fax:
Practice Address - Street 1:727 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-1515
Practice Address - Country:US
Practice Address - Phone:352-528-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37356183500000X
FLNP3231835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear