Provider Demographics
NPI:1528604873
Name:LAWSON, JAY KYLE
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KYLE
Last Name:LAWSON
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 1:1660 CRAWFORDSVILLE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3800
Mailing Address - Country:US
Mailing Address - Phone:765-361-3260
Mailing Address - Fax:765-361-3262
Practice Address - Street 1:1660 CRAWFORDSVILLE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3800
Practice Address - Country:US
Practice Address - Phone:765-361-3260
Practice Address - Fax:765-361-3262
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020460A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist