Healthcare Provider Details

I. General information

NPI: 1942509567
Provider Name (Legal Business Name): LAWRENCE L VIERRA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N GOLDEN STATE BLVD
TURLOCK CA
95380-3952
US

IV. Provider business mailing address

2517 CASWELL AVE
CERES CA
95307-2307
US

V. Phone/Fax

Practice location:
  • Phone: 209-634-5831
  • Fax:
Mailing address:
  • Phone: 209-537-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: