Healthcare Provider Details

I. General information

NPI: 1295988954
Provider Name (Legal Business Name): LEANNE MARIE LAWRENCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 CHERRY VALLEY AVE. SE
CALEDONIA MI
49316-9506
US

IV. Provider business mailing address

9375 CHERRY VALLEY AVE. SE
CALEDONIA MI
49316-9506
US

V. Phone/Fax

Practice location:
  • Phone: 616-891-7898
  • Fax: 616-891-8097
Mailing address:
  • Phone: 616-891-7898
  • Fax: 616-891-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: