Provider Demographics
NPI:1356837140
Name:IVANOV, LINA VIKTOROVNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:VIKTOROVNA
Last Name:IVANOV
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 1:19A COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9438
Mailing Address - Country:US
Mailing Address - Phone:828-337-9636
Mailing Address - Fax:
Practice Address - Street 1:1572 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-0228
Practice Address - Country:US
Practice Address - Phone:828-665-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist