Healthcare Provider Details

I. General information

NPI: 1780098905
Provider Name (Legal Business Name): MR. JAMES LAWLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 UNION ST
AUBURN ME
04210-5475
US

IV. Provider business mailing address

61 UNION ST
AUBURN ME
04210-5475
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-0506
  • Fax:
Mailing address:
  • Phone: 207-753-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR12519
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: