Provider Demographics
NPI:1093831679
Name:LOVELACE, MARK DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-9538
Mailing Address - Country:US
Mailing Address - Phone:704-730-8190
Mailing Address - Fax:704-734-0936
Practice Address - Street 1:1114 WEST GOLD STREET
Practice Address - Street 2:EXTENSION
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086
Practice Address - Country:US
Practice Address - Phone:704-739-4519
Practice Address - Fax:704-734-0936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist