Provider Demographics
NPI:1063009447
Name:LUBONSKI, LAWRENCE J (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:LUBONSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8887
Mailing Address - Country:US
Mailing Address - Phone:614-749-0711
Mailing Address - Fax:
Practice Address - Street 1:1101 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8887
Practice Address - Country:US
Practice Address - Phone:614-751-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03539262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03539262OtherPHARMACIST LICENSE