=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427122910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1156 GEORGE WASHINGTON HWY N
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23323-4908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-487-3458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1156 GEORGE WASHINGTON HWY N
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23323-4908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-487-3458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEAD CLERK
-----------------------------------------------------
Name | SANDY RENSLOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-487-3458
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0201000416
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------