Provider Demographics
NPI:1609166651
Name:LAVENDER, ELIZABETH LEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LEE
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6765
Mailing Address - Country:US
Mailing Address - Phone:704-481-8557
Mailing Address - Fax:704-481-8529
Practice Address - Street 1:231 E DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6765
Practice Address - Country:US
Practice Address - Phone:704-481-8557
Practice Address - Fax:704-481-8529
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist