Provider Demographics
NPI:1124355482
Name:ELATTRACHE, LAWRENCE M (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:M
Last Name:ELATTRACHE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 N WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4620
Mailing Address - Country:US
Mailing Address - Phone:325-676-2392
Mailing Address - Fax:325-676-8239
Practice Address - Street 1:991 N WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4620
Practice Address - Country:US
Practice Address - Phone:325-676-2392
Practice Address - Fax:325-676-8239
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist