Provider Demographics
NPI:1568748341
Name:LAWICKI, MARK JAMES (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:LAWICKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6041
Mailing Address - Country:US
Mailing Address - Phone:209-524-6107
Mailing Address - Fax:
Practice Address - Street 1:995 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9262
Practice Address - Country:US
Practice Address - Phone:209-894-3700
Practice Address - Fax:209-894-3707
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46275OtherPHARMACIST