Healthcare Provider Details

I. General information

NPI: 1487973053
Provider Name (Legal Business Name): LAWRENCE EUGENE HORTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18880 CHERRY VALLEY BLVD
TUOLUMNE CA
95379-9506
US

IV. Provider business mailing address

1032 SANDALWOOD DR P O BOX 2667
MURPHYS CA
95247-9664
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5407
  • Fax:
Mailing address:
  • Phone: 209-728-9180
  • Fax: 209-728-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: