Healthcare Provider Details

I. General information

NPI: 1740827161
Provider Name (Legal Business Name): AMY J. LAZETTE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY J. LAZETTE-DAUSS

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S MONROE ST
MONROE MI
48161-1480
US

IV. Provider business mailing address

1932 STUMPMIER RD
MONROE MI
48162-9480
US

V. Phone/Fax

Practice location:
  • Phone: 734-755-2246
  • Fax:
Mailing address:
  • Phone: 734-755-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: