MEDICARE: RICHARD ARDEN LAWRENCE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS42348	FL

General Provider Information

NPI Number	:	1578703575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ARDEN LAWRENCE PHARMD

Provider Business Mailing Address
First Line	:	3594 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8016
Country	:	US
Telephone Number	:	239-939-0249
Fax Number	:	239-936-2427

Provider Business Practice Location Address
First Line	:	3594 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8016
Country	:	US
Telephone Number	:	239-939-0249
Fax Number	:	239-936-2427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	03/03/2009

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