Provider Demographics
NPI:1194019380
Name:LAWSON, CATHY (RPH)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 24TH AVE
Mailing Address - Street 2:T-0632
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3806
Mailing Address - Country:US
Mailing Address - Phone:810-385-5930
Mailing Address - Fax:810-385-5930
Practice Address - Street 1:4300 24TH AVE
Practice Address - Street 2:T-0632
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3806
Practice Address - Country:US
Practice Address - Phone:810-385-5930
Practice Address - Fax:810-385-5930
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183500000X PHARMACISOther#18 PHARMACY SERVICE PROVIDERS