Healthcare Provider Details

I. General information

NPI: 1326355975
Provider Name (Legal Business Name): LAWRENCE KAUFMAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W MAIN ST
MAPLE SHADE NJ
08052-2411
US

IV. Provider business mailing address

25 W MAIN ST
MAPLE SHADE NJ
08052-2411
US

V. Phone/Fax

Practice location:
  • Phone: 856-779-8300
  • Fax: 856-779-9022
Mailing address:
  • Phone: 856-779-8300
  • Fax: 856-779-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01790800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: