Individual
GRANT LAWSON BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 MICHIGAN ST NW APT 910, GRAND RAPIDS, MI 49503-2330
(616) 824-6200
Mailing address
201 MICHIGAN ST NW APT 910, GRAND RAPIDS, MI 49503-2330
(616) 824-6200
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5351010562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B200288488123
DRIVERS LICENSE
MI
Enumeration date
01/07/2020
Last updated
01/07/2020
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