Provider Demographics
NPI:1477834786
Name:LAWRENCE, MICHAEL GENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GENE
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 287TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4343
Mailing Address - Country:US
Mailing Address - Phone:763-389-7993
Mailing Address - Fax:
Practice Address - Street 1:3470 RIVER RAPIDS DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-4101
Practice Address - Country:US
Practice Address - Phone:763-427-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist