Provider Demographics
NPI:1891129631
Name:BLACKMON LEVERIS, MARCIA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:MICHELLE
Last Name:BLACKMON LEVERIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 ZACKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6881
Mailing Address - Country:US
Mailing Address - Phone:919-291-4483
Mailing Address - Fax:
Practice Address - Street 1:4500 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3614
Practice Address - Country:US
Practice Address - Phone:919-772-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist