Provider Demographics
NPI:1598169799
Name:LAWRENCE, CORIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CORIE
Other - Middle Name:
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-252-7024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist