Provider Demographics
NPI:1184872640
Name:LUMBRAZO, JODIE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:ANN
Last Name:LUMBRAZO
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 1:70 CRAPE MYRTLE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8034
Mailing Address - Country:US
Mailing Address - Phone:919-938-3800
Mailing Address - Fax:919-938-3801
Practice Address - Street 1:70 CRAPE MYRTLE DR STE 103
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:919-938-3800
Practice Address - Fax:919-938-3801
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0435478Medicaid
NC0435478Medicaid
NC4245350002Medicare NSC