Provider Demographics
NPI:1588082523
Name:FORD, LAWRENCE
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:37 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6628
Mailing Address - Country:US
Mailing Address - Phone:207-985-7144
Mailing Address - Fax:
Practice Address - Street 1:37 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6628
Practice Address - Country:US
Practice Address - Phone:207-985-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3113183500000X
MAPH14944183500000X
NHR1022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist