Provider Demographics
NPI:1588980940
Name:KECKLER, LAWRENCE W (RPH)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:KECKLER
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 1:330 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3107
Mailing Address - Country:US
Mailing Address - Phone:203-481-0386
Mailing Address - Fax:203-488-3126
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3107
Practice Address - Country:US
Practice Address - Phone:203-481-0386
Practice Address - Fax:203-488-3126
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist