Healthcare Provider Details

I. General information

NPI: 1982985602
Provider Name (Legal Business Name): JOHN EDWARD LAWSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W. GRAND
SPRINGFIELD MO
65802-4870
US

IV. Provider business mailing address

3872 E STANFORD ST
SPRINGFIELD MO
65809-2270
US

V. Phone/Fax

Practice location:
  • Phone: 417-874-7428
  • Fax: 417-874-7430
Mailing address:
  • Phone: 417-773-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2000145235
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: