Provider Demographics
NPI:1578773891
Name:BANJOKO, LAWRENCE
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:BANJOKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AYOKUNNU
Other - Middle Name:
Other - Last Name:BANJOKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PD , RPH
Mailing Address - Street 1:591 FELIX CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2512
Mailing Address - Country:US
Mailing Address - Phone:410-420-7242
Mailing Address - Fax:410-933-7669
Practice Address - Street 1:4920 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5916
Practice Address - Country:US
Practice Address - Phone:410-933-7626
Practice Address - Fax:410-933-7669
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist