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General NPI Number Information
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NPI Number | 1073806402
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Entity Type | Individual
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Provider Name | LAWRENCE MATTHEW SMITH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 2851 HENLEY RD
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-7204
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Country | US
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Telephone | 904-899-6902
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Fax | 904-291-3288
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Provider Business Mailing Address
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Address Line | 2851 HENLEY RD
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-7204
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Country | US
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Telephone | 904-744-8425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS44945
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License Number State | FL
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