Provider Demographics
NPI:1902175185
Name:COLEMAN, LAWRENCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHARMD
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 370694
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0694
Mailing Address - Country:US
Mailing Address - Phone:323-394-7599
Mailing Address - Fax:888-731-4005
Practice Address - Street 1:503 S FLOWER ST
Practice Address - Street 2:#1
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2863
Practice Address - Country:US
Practice Address - Phone:888-731-4005
Practice Address - Fax:888-731-4005
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist