Healthcare Provider Details

I. General information

NPI: 1710581632
Provider Name (Legal Business Name): MARK ALEXANDER LAWSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD
LANSING MI
48912-3756
US

IV. Provider business mailing address

7272 RENWOOD CT
WASHINGTON MI
48095-1243
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-1950
  • Fax:
Mailing address:
  • Phone: 816-868-4703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302413016
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: