MEDICARE: AMANDA M LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302037938	MI

General Provider Information

NPI Number	:	1366073231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA M LAWRENCE

Provider Business Mailing Address
First Line	:	225 E STATE ST
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9004
Country	:	US
Telephone Number	:	810-639-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 E STATE ST
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9004
Country	:	US
Telephone Number	:	810-639-0049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ AMANDA M LAWRENCE ” Practice Location

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