Provider Demographics
NPI:1942509567
Name:VIERRA, LAWRENCE L (RPH)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:VIERRA
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 1:2517 CASWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2307
Mailing Address - Country:US
Mailing Address - Phone:209-537-3413
Mailing Address - Fax:
Practice Address - Street 1:651 N GOLDEN STATE BLVD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3952
Practice Address - Country:US
Practice Address - Phone:209-634-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist