Provider Demographics
NPI:1831979640
Name:ZHURAVLEVA, KSENIA
Entity type:Individual
Prefix:
First Name:KSENIA
Middle Name:
Last Name:ZHURAVLEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5551
Mailing Address - Country:US
Mailing Address - Phone:423-747-0010
Mailing Address - Fax:
Practice Address - Street 1:6330 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2862
Practice Address - Country:US
Practice Address - Phone:910-860-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist