Provider Demographics
NPI:1205983681
Name:LOWDERMILK, EDWARD LENOIR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LENOIR
Last Name:LOWDERMILK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1821
Mailing Address - Country:US
Mailing Address - Phone:191-933-8494
Mailing Address - Fax:919-933-9201
Practice Address - Street 1:224 SOUTH 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344
Practice Address - Country:US
Practice Address - Phone:919-663-1744
Practice Address - Fax:919-663-1635
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCOTH000Medicare ID - Type Unspecified
NCOTH000Medicare UPIN