Provider Demographics
NPI:1871193839
Name:LAWRENZ, CAROL ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:LAWRENZ
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 1:5780 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7844
Mailing Address - Country:US
Mailing Address - Phone:219-872-3312
Mailing Address - Fax:219-874-3284
Practice Address - Street 1:5780 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7844
Practice Address - Country:US
Practice Address - Phone:219-872-3309
Practice Address - Fax:219-874-3284
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015390A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist