Provider Demographics
NPI:1184839144
Name:SIROIS, LAURENCE MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:MICHAEL
Last Name:SIROIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59636 E BROCKTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-1957
Mailing Address - Country:US
Mailing Address - Phone:586-945-3091
Mailing Address - Fax:
Practice Address - Street 1:1633 FAIRLANE CIR
Practice Address - Street 2:SUITE 165
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3660
Practice Address - Country:US
Practice Address - Phone:313-271-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist