Provider Demographics
NPI:1982985602
Name:LAWSON, JOHN EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:LAWSON
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 1:3872 E STANFORD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2270
Mailing Address - Country:US
Mailing Address - Phone:417-773-9727
Mailing Address - Fax:
Practice Address - Street 1:1720 W. GRAND
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-4870
Practice Address - Country:US
Practice Address - Phone:417-874-7428
Practice Address - Fax:417-874-7430
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000145235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist