Provider Demographics
NPI:1184983009
Name:LAWLESS, JOHANNA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:M
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13050 W WEATHER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9025
Mailing Address - Country:US
Mailing Address - Phone:262-821-5870
Mailing Address - Fax:
Practice Address - Street 1:5600 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-1910
Practice Address - Country:US
Practice Address - Phone:414-529-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-12
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1489440183500000X
IL051041034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist