Provider Demographics
NPI:1124305925
Name:WOEBER, LAWRENCE
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:WOEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18215 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3330
Mailing Address - Country:US
Mailing Address - Phone:561-746-0643
Mailing Address - Fax:561-627-9413
Practice Address - Street 1:18215 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-746-0643
Practice Address - Fax:561-627-9413
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS16187Medicare UPIN