Provider Demographics
NPI:1801289137
Name:LAWIE, KORI M (PHAMD, RPH)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:M
Last Name:LAWIE
Suffix:
Gender:M
Credentials:PHAMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 16TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1600
Mailing Address - Country:US
Mailing Address - Phone:727-290-8024
Mailing Address - Fax:
Practice Address - Street 1:33 16TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1600
Practice Address - Country:US
Practice Address - Phone:727-290-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist