Healthcare Provider Details

I. General information

NPI: 1518090398
Provider Name (Legal Business Name): BADWAY'S LAWRENCE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 RTE. 173
BLOOMSBURY NJ
08804
US

IV. Provider business mailing address

PO BOX 396 964 STATE HWY 173
BLOOMSBURY NJ
08804-0396
US

V. Phone/Fax

Practice location:
  • Phone: 908-479-4617
  • Fax: 908-479-4619
Mailing address:
  • Phone: 908-479-4617
  • Fax: 908-479-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00276200
License Number StateNJ

VIII. Authorized Official

Name: LAWRENCE M. BADWAY
Title or Position: OWNER, PHARMACIST
Credential: R.PH.
Phone: 908-479-4617