Provider Demographics
NPI:1508014945
Name:LINGAYAT, SUBODHA
Entity Type:Individual
Prefix:
First Name:SUBODHA
Middle Name:
Last Name:LINGAYAT
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 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2655
Mailing Address - Country:US
Mailing Address - Phone:252-447-6303
Mailing Address - Fax:252-447-3710
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2655
Practice Address - Country:US
Practice Address - Phone:252-447-6303
Practice Address - Fax:252-447-3710
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist