Provider Demographics
NPI:1043737455
Name:LAWRENCE, CORIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CORIE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-0658
Mailing Address - Country:US
Mailing Address - Phone:601-303-7890
Mailing Address - Fax:
Practice Address - Street 1:3000 PLAZA DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-9227
Practice Address - Country:US
Practice Address - Phone:601-876-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-8773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist