Provider Demographics
NPI:1457515637
Name:LAWRENCE, JIJIMOL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JIJIMOL
Middle Name:
Last Name:LAWRENCE
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 1:1250 UPPER FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1608
Mailing Address - Country:US
Mailing Address - Phone:607-723-8291
Mailing Address - Fax:607-651-9992
Practice Address - Street 1:1250 UPPER FRONT ST STE 18
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1069
Practice Address - Country:US
Practice Address - Phone:607-723-8291
Practice Address - Fax:607-651-9992
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist