Provider Demographics
NPI:1619248663
Name:SCRUGGS, LYNN ETTERS (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ETTERS
Last Name:SCRUGGS
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 1:300 E GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3920
Mailing Address - Country:US
Mailing Address - Phone:704-482-4429
Mailing Address - Fax:704-484-6965
Practice Address - Street 1:300 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3920
Practice Address - Country:US
Practice Address - Phone:704-482-4429
Practice Address - Fax:704-484-6965
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist