Healthcare Provider Details

I. General information

NPI: 1881685691
Provider Name (Legal Business Name): LAWRENCE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 E REPUBLIC RD
SPRINGFIELD MO
65804-6507
US

IV. Provider business mailing address

1454 E REPUBLIC RD
SPRINGFIELD MO
65804-6507
US

V. Phone/Fax

Practice location:
  • Phone: 417-886-6880
  • Fax: 417-886-0042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005236
License Number StateMO

VIII. Authorized Official

Name: KENNETH LAWRENCE
Title or Position: OWNER
Credential: RPH
Phone: 417-886-6880