Provider Demographics
NPI:1710546320
Name:YSIDRON, DENISE M
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:YSIDRON
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 1:2316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3655
Mailing Address - Country:US
Mailing Address - Phone:336-243-2428
Mailing Address - Fax:
Practice Address - Street 1:2316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3655
Practice Address - Country:US
Practice Address - Phone:336-243-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist