Provider Demographics
NPI:1588964993
Name:LAWRENCE, KATRINA (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32178 S BURKERT RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-8720
Mailing Address - Country:US
Mailing Address - Phone:503-634-2812
Mailing Address - Fax:503-634-5008
Practice Address - Street 1:1525 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-7362
Practice Address - Country:US
Practice Address - Phone:503-829-4855
Practice Address - Fax:503-829-3486
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist