Provider Demographics
NPI:1710219951
Name:LAWSON, BRADFORD D (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:D
Last Name:LAWSON
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 1:102 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5501
Mailing Address - Country:US
Mailing Address - Phone:304-623-4488
Mailing Address - Fax:304-623-0157
Practice Address - Street 1:102 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5501
Practice Address - Country:US
Practice Address - Phone:304-623-4488
Practice Address - Fax:304-623-0157
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist