Provider Demographics
NPI:1275913816
Name:BALDASSANO, LAWRENCE CHARLES
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CHARLES
Last Name:BALDASSANO
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 1:908 SAINT CLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2829
Mailing Address - Country:US
Mailing Address - Phone:610-420-2721
Mailing Address - Fax:
Practice Address - Street 1:908 SAINT CLAIRE LN
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2829
Practice Address - Country:US
Practice Address - Phone:610-420-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024522L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist