Provider Demographics
NPI:1518204114
Name:NANCARROW, LAVILA C
Entity Type:Individual
Prefix:MRS
First Name:LAVILA
Middle Name:C
Last Name:NANCARROW
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 1:11600 GLADIOLUS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4567
Mailing Address - Country:US
Mailing Address - Phone:239-437-3681
Mailing Address - Fax:239-437-6133
Practice Address - Street 1:11600 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4567
Practice Address - Country:US
Practice Address - Phone:239-437-3681
Practice Address - Fax:239-437-6133
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist