Provider Demographics
NPI:1073985362
Name:LAMARQUE, JONATHON
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:LAMARQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 BEAVER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3347
Mailing Address - Country:US
Mailing Address - Phone:831-277-1871
Mailing Address - Fax:402-792-0010
Practice Address - Street 1:18780 S 68TH ST STE B
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:NE
Practice Address - Zip Code:68372-7083
Practice Address - Country:US
Practice Address - Phone:402-792-0006
Practice Address - Fax:402-792-0010
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist