Provider Demographics
NPI:1740469337
Name:LENNON, LAURA GAITHER (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GAITHER
Last Name:LENNON
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 1:2421 OLD TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3439
Mailing Address - Country:US
Mailing Address - Phone:336-282-5855
Mailing Address - Fax:336-282-5855
Practice Address - Street 1:510 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3663
Practice Address - Country:US
Practice Address - Phone:336-992-2111
Practice Address - Fax:336-992-2113
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0347199Medicaid
NC0347199Medicaid