Provider Demographics
NPI:1023717196
Name:SCHAFER, LAWRENCE ALTON III
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALTON
Last Name:SCHAFER
Suffix:III
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 1:9616 COUNTY ROAD 403
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-8902
Mailing Address - Country:US
Mailing Address - Phone:812-256-6368
Mailing Address - Fax:
Practice Address - Street 1:9616 COUNTY ROAD 403
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8902
Practice Address - Country:US
Practice Address - Phone:812-256-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030179A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist