Provider Demographics
NPI:1558546143
Name:LASEK, STEVEN LAWRENCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LAWRENCE
Last Name:LASEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 ST RT 49
Mailing Address - Street 2:
Mailing Address - City:CONSTANTIA
Mailing Address - State:NY
Mailing Address - Zip Code:13044-2775
Mailing Address - Country:US
Mailing Address - Phone:315-326-7706
Mailing Address - Fax:
Practice Address - Street 1:1274 STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:CONSTANTIA
Practice Address - State:NY
Practice Address - Zip Code:13044-2775
Practice Address - Country:US
Practice Address - Phone:315-326-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482908Medicaid