Provider Demographics
NPI:1013059203
Name:MEREDITH, LONNIE LAVAUGHN (RPH)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:LAVAUGHN
Last Name:MEREDITH
Suffix:
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 1:507 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-4507
Mailing Address - Country:US
Mailing Address - Phone:940-864-2673
Mailing Address - Fax:940-864-3731
Practice Address - Street 1:100 S AVENUE E
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5711
Practice Address - Country:US
Practice Address - Phone:940-864-2673
Practice Address - Fax:940-864-3731
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28628OtherSTATE PHARMACY LICENSE