Provider Demographics
NPI:1487642245
Name:LAWRENCE, GRACE ANNE (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ANNE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7562
Mailing Address - Country:US
Mailing Address - Phone:208-890-6811
Mailing Address - Fax:208-424-8903
Practice Address - Street 1:10464 GARVERDALE CT
Practice Address - Street 2:SUITE 706
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5410
Practice Address - Country:US
Practice Address - Phone:208-323-1259
Practice Address - Fax:208-323-5666
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5050183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric