Healthcare Provider Details

I. General information

NPI: 1083994792
Provider Name (Legal Business Name): CHARLES PHILLIP LAWRENCE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9458 HELENA RD
PELHAM AL
35124-2743
US

IV. Provider business mailing address

9458 HELENA RD
PELHAM AL
35124-2743
US

V. Phone/Fax

Practice location:
  • Phone: 205-444-9488
  • Fax: 205-989-8478
Mailing address:
  • Phone: 205-999-2885
  • Fax: 205-989-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15565
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: