MEDICARE: MR. LAWRENCE ALBERT SMITH, JR RPH

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	10517	GA

General Provider Information

NPI Number	:	1760517957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE ALBERT SMITH, JR RPH

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0128
Country	:	US
Telephone Number	:	912-363-4979
Fax Number	:	912-363-8453

Provider Business Practice Location Address
First Line	:	LUMBER CITY DRUGS, INC
Second Line	:	HWY 341 SOUTH
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0128
Country	:	US
Telephone Number	:	912-363-4979
Fax Number	:	912-363-8453

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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