Healthcare Provider Details

I. General information

NPI: 1811535131
Provider Name (Legal Business Name): RONALD GARRETT LAWRENCE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 2ND AVE NE
FAYETTE AL
35555-1739
US

IV. Provider business mailing address

1128 2ND AVE NE
FAYETTE AL
35555-1739
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-5400
  • Fax: 205-932-5401
Mailing address:
  • Phone: 205-932-5400
  • Fax: 205-932-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12058
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: