Provider Demographics
NPI:1013402619
Name:LASCANO, BIANCA XIOMARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:XIOMARA
Last Name:LASCANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CLUBHOUSE CT APT 2G
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8194
Mailing Address - Country:US
Mailing Address - Phone:757-284-6004
Mailing Address - Fax:
Practice Address - Street 1:2125 CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2506
Practice Address - Country:US
Practice Address - Phone:336-723-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANA183500000X
NC29749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist