Provider Demographics
NPI:1275865214
Name:LAWATSCH, JOHN OSCAR (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OSCAR
Last Name:LAWATSCH
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 1:105 W MILLER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1422
Mailing Address - Country:US
Mailing Address - Phone:315-331-6128
Mailing Address - Fax:315-331-6289
Practice Address - Street 1:105 W MILLER ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1422
Practice Address - Country:US
Practice Address - Phone:315-331-6128
Practice Address - Fax:315-331-6289
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist