Provider Demographics
NPI:1669512745
Name:LAWHORN, PEGGY LOUISE (RPH)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:LOUISE
Last Name:LAWHORN
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 1:211 COVINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-2053
Mailing Address - Country:US
Mailing Address - Phone:864-294-6429
Mailing Address - Fax:
Practice Address - Street 1:2956 NEW EASLEY HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7132
Practice Address - Country:US
Practice Address - Phone:864-295-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC700551Medicaid
SC1538199260Medicare UPIN