Provider Demographics
NPI:1164797353
Name:LORSON, MARK VERNON II (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:VERNON
Last Name:LORSON
Suffix:II
Gender:M
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NAUTILUS DR APT 8
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4358
Mailing Address - Country:US
Mailing Address - Phone:414-207-0309
Mailing Address - Fax:
Practice Address - Street 1:211 NAUTILUS DR APT 8
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4358
Practice Address - Country:US
Practice Address - Phone:414-207-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15547-401835G0303X
OH031298161835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric