Provider Demographics
NPI:1730694761
Name:DAVIDOW, LAWRENCE WAYNE (PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:DAVIDOW
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1620
Mailing Address - Country:US
Mailing Address - Phone:785-864-4527
Mailing Address - Fax:785-864-5562
Practice Address - Street 1:2010 BECKER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1620
Practice Address - Country:US
Practice Address - Phone:785-864-4527
Practice Address - Fax:785-864-5562
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist