Provider Demographics
NPI:1205412657
Name:HARRIS CARNEY, LUCILLE TRAVETTA
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:TRAVETTA
Last Name:HARRIS CARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SHEILA LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2040
Mailing Address - Country:US
Mailing Address - Phone:804-320-0099
Mailing Address - Fax:
Practice Address - Street 1:2410 SHEILA LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2040
Practice Address - Country:US
Practice Address - Phone:804-320-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230030776183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician