Provider Demographics
NPI:1023331212
Name:LAWLESS, AMY LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:LAWLESS
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 1:4111 PLAINFIELD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1609
Mailing Address - Country:US
Mailing Address - Phone:616-364-6147
Mailing Address - Fax:616-364-6479
Practice Address - Street 1:4111 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1609
Practice Address - Country:US
Practice Address - Phone:616-364-6147
Practice Address - Fax:616-364-6479
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist