Provider Demographics
NPI:1144512005
Name:AUDLEY, LAWRENCE ALBERT (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALBERT
Last Name:AUDLEY
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5110
Mailing Address - Country:US
Mailing Address - Phone:615-904-9907
Mailing Address - Fax:615-867-9952
Practice Address - Street 1:2485 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5110
Practice Address - Country:US
Practice Address - Phone:615-904-9907
Practice Address - Fax:615-867-9952
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist