Provider Demographics
NPI:1518090398
Name:BADWAY'S LAWRENCE PHARMACY INC
Entity Type:Organization
Organization Name:BADWAY'S LAWRENCE PHARMACY INC
Other - Org Name:LAWRENCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-479-4617
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:964 STATE HWY 173
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-0396
Mailing Address - Country:US
Mailing Address - Phone:908-479-4617
Mailing Address - Fax:908-479-4619
Practice Address - Street 1:964 RTE. 173
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804
Practice Address - Country:US
Practice Address - Phone:908-479-4617
Practice Address - Fax:908-479-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS002762003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4319702Medicaid
NJ4319702Medicaid
NJ4319702Medicaid