Provider Demographics
NPI:1255404901
Name:LAWSON, MARK ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:LAWSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4515
Mailing Address - Country:US
Mailing Address - Phone:610-485-7750
Mailing Address - Fax:
Practice Address - Street 1:46 E 10TH ST
Practice Address - Street 2:
Practice Address - City:MARCUS HOOK
Practice Address - State:PA
Practice Address - Zip Code:19061-4515
Practice Address - Country:US
Practice Address - Phone:610-485-7750
Practice Address - Fax:610-485-2459
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10222731260004Medicaid
DE1265673586Medicaid
DE1265673586Medicaid
PA6357440001Medicare NSC