Provider Demographics
NPI:1457594715
Name:GARCIA, LONI T (RPH)
Entity Type:Individual
Prefix:
First Name:LONI
Middle Name:T
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LONI
Other - Middle Name:CAMILLE
Other - Last Name:TRAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5429
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-0429
Mailing Address - Country:US
Mailing Address - Phone:423-239-0679
Mailing Address - Fax:423-239-0673
Practice Address - Street 1:1911 MORELAND DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3018
Practice Address - Country:US
Practice Address - Phone:423-239-0679
Practice Address - Fax:423-239-0673
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8619183500000X
NC7018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8619OtherTENNESSEE PHARMACIST LICENSE
NC7018OtherNC PHARMACIST LICENSE NUMBER