Provider Demographics
NPI:1194000687
Name:LERNOR, LAWRENCE ROGER (RPH)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ROGER
Last Name:LERNOR
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 1:830 EAST BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2355
Mailing Address - Country:US
Mailing Address - Phone:630-410-0709
Mailing Address - Fax:630-410-0706
Practice Address - Street 1:830 EAST BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2355
Practice Address - Country:US
Practice Address - Phone:630-410-0709
Practice Address - Fax:630-410-0706
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist