Provider Demographics
NPI:1760838643
Name:BADWAY, LAWRENCE MICHAEL
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:BADWAY
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 1:964 RTE 173
Mailing Address - Street 2:PO BOX 396
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-3112
Mailing Address - Country:US
Mailing Address - Phone:908-479-4617
Mailing Address - Fax:908-479-4619
Practice Address - Street 1:964 RTE 173
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804-3112
Practice Address - Country:US
Practice Address - Phone:908-479-4617
Practice Address - Fax:908-479-4619
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI020128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist