Provider Demographics
NPI:1912471459
Name:SILAVANH, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:SILAVANH
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 1:11120 BENNETT DR UNIT 47
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1141
Mailing Address - Country:US
Mailing Address - Phone:941-993-2639
Mailing Address - Fax:
Practice Address - Street 1:2316 WALKER BUILDING
Practice Address - Street 2:
Practice Address - City:AUBURN UNIVERSITY
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:941-993-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist