Provider Demographics
NPI:1740827161
Name:LAZETTE, AMY J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:LAZETTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:LAZETTE-DAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 STUMPMIER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9480
Mailing Address - Country:US
Mailing Address - Phone:734-755-2246
Mailing Address - Fax:
Practice Address - Street 1:23849 WEST RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-9310
Practice Address - Country:US
Practice Address - Phone:734-755-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist