Provider Demographics
NPI:1255653275
Name:SHUFORD, MARIE LEWIS
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LEWIS
Last Name:SHUFORD
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 1:1719 CAVENDISH CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3945
Mailing Address - Country:US
Mailing Address - Phone:704-364-9815
Mailing Address - Fax:
Practice Address - Street 1:1716 PLEASANT RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7815
Practice Address - Country:US
Practice Address - Phone:803-802-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10103183500000X
SC11696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist