Provider Demographics
NPI:1790071447
Name:FOX, LANCE KEVIN SR (RPH)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:KEVIN
Last Name:FOX
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4806
Mailing Address - Country:US
Mailing Address - Phone:336-297-1467
Mailing Address - Fax:336-297-1794
Practice Address - Street 1:3330 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4806
Practice Address - Country:US
Practice Address - Phone:336-297-1467
Practice Address - Fax:336-297-1794
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist