Provider Demographics
NPI:1396185377
Name:LAMAR, VENECIA
Entity Type:Individual
Prefix:DR
First Name:VENECIA
Middle Name:
Last Name:LAMAR
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 1:2300 UNION GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5051
Mailing Address - Country:US
Mailing Address - Phone:770-355-1174
Mailing Address - Fax:
Practice Address - Street 1:2300 UNION GROVE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5051
Practice Address - Country:US
Practice Address - Phone:770-355-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist