1467734368 NPI number — DR. PHILLIP TYLER LAWRENCE PHARM. D

Table of content: DR. PHILLIP TYLER LAWRENCE PHARM. D (NPI 1467734368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467734368 NPI number — DR. PHILLIP TYLER LAWRENCE PHARM. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
PHILLIP
Provider Middle Name:
TYLER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM. D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467734368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14555 W MAUNA LOA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85379-4752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-941-0580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21025 N 8TH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85024-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-815-8965
Provider Business Practice Location Address Fax Number:
623-815-1222
Provider Enumeration Date:
09/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  S018577 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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