Healthcare Provider Details

I. General information

NPI: 1497278535
Provider Name (Legal Business Name): MICHAEL DAVID LAWRENCE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 RESERVATION RD
LA CONNER WA
98257-8801
US

IV. Provider business mailing address

17400 RESERVATION RD
LA CONNER WA
98257-8801
US

V. Phone/Fax

Practice location:
  • Phone: 360-466-3167
  • Fax: 360-466-5528
Mailing address:
  • Phone: 360-466-3167
  • Fax: 360-466-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHA-PHA-LIC-47029
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60769543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: