Basic Information
Provider Information
NPI: 1780098905
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAWLOR
FirstName: JAMES
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 61 UNION ST
Address2:  
City: AUBURN
State: ME
PostalCode: 042105475
CountryCode: US
TelephoneNumber: 2077530506
FaxNumber:  
Practice Location
Address1: 61 UNION ST
Address2:  
City: AUBURN
State: ME
PostalCode: 042105475
CountryCode: US
TelephoneNumber: 2077530506
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2014
LastUpdateDate: 06/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPR12519MEY Pharmacy Service ProvidersPharmacist 

No ID Information.


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