Provider Demographics
NPI:1871892471
Name:BORRUSCH, LAWRENCE PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:PAUL
Last Name:BORRUSCH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9305
Mailing Address - Country:US
Mailing Address - Phone:231-348-2767
Mailing Address - Fax:231-487-0755
Practice Address - Street 1:1133 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9305
Practice Address - Country:US
Practice Address - Phone:231-348-2767
Practice Address - Fax:231-487-0755
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist