Provider Demographics
NPI:1801148010
Name:LAKOMSKI, MARY JOANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOANNE
Last Name:LAKOMSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3287 GREENLEAFE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-1538
Mailing Address - Country:US
Mailing Address - Phone:315-464-9918
Mailing Address - Fax:315-464-3872
Practice Address - Street 1:90 PRESIDENTIAL PLAZA
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-9918
Practice Address - Fax:315-464-3872
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist