Provider Demographics
NPI:1225550510
Name:SALMON, LAUREN LIVESAY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LIVESAY
Last Name:SALMON
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 1:2617 FARLOW GAP LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5943
Mailing Address - Country:US
Mailing Address - Phone:804-731-1665
Mailing Address - Fax:
Practice Address - Street 1:3201 EDWARDS MILL RD STE 123
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5370
Practice Address - Country:US
Practice Address - Phone:919-781-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-09
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist