Provider Demographics
NPI:1992089759
Name:FREY, LAWRENCE PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:PAUL
Last Name:FREY
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 1:1705 SHACKELFORD RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2718
Mailing Address - Country:US
Mailing Address - Phone:314-831-5559
Mailing Address - Fax:314-831-7981
Practice Address - Street 1:1705 SHACKELFORD RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2718
Practice Address - Country:US
Practice Address - Phone:314-831-5559
Practice Address - Fax:314-831-7981
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist