Provider Demographics
NPI:1043734767
Name:LAVOTCHIN, ANNA IVANOVNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:IVANOVNA
Last Name:LAVOTCHIN
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 1:3 EARLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-1982
Mailing Address - Country:US
Mailing Address - Phone:864-915-9766
Mailing Address - Fax:
Practice Address - Street 1:820 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-9001
Practice Address - Country:US
Practice Address - Phone:864-476-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist