Provider Demographics
NPI:1700386653
Name:LAVARNWAY, ADAM JAMES
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
Last Name:LAVARNWAY
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 1:47 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1509
Mailing Address - Country:US
Mailing Address - Phone:518-572-5311
Mailing Address - Fax:
Practice Address - Street 1:357 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2211
Practice Address - Country:US
Practice Address - Phone:518-561-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063878183500000X
NC27453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist