Provider Demographics
NPI:1578037800
Name:LAWRENCE, TANIKA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANIKA
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 RED ROCK PT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4080
Mailing Address - Country:US
Mailing Address - Phone:678-458-3313
Mailing Address - Fax:
Practice Address - Street 1:4340 RED ROCK PT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4080
Practice Address - Country:US
Practice Address - Phone:678-458-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist