Provider Demographics
NPI:1376845925
Name:CLEVINGER, LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CLEVINGER
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 1:4307 N ROAN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-5036
Mailing Address - Country:US
Mailing Address - Phone:423-952-0088
Mailing Address - Fax:
Practice Address - Street 1:4307 N ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-5036
Practice Address - Country:US
Practice Address - Phone:423-952-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35525183500000X
VA0202208726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist