Healthcare Provider Details

I. General information

NPI: 1336819366
Provider Name (Legal Business Name): ZACHARY LAWRENCE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZAC LAWRENCE PHARMD

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W MAIN ST
TUPELO MS
38801-3538
US

IV. Provider business mailing address

960 W MAIN ST
TUPELO MS
38801-3538
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-8559
  • Fax: 662-680-4182
Mailing address:
  • Phone: 662-840-8559
  • Fax: 662-680-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45483
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-100398
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: