1457594715 NPI number — LONI T GARCIA RPH

Table of content: LONI T GARCIA RPH (NPI 1457594715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457594715 NPI number — LONI T GARCIA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
LONI
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAYLOR
Provider Other First Name:
LONI
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457594715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37663-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-239-0679
Provider Business Mailing Address Fax Number:
423-239-0673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 MORELAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37663-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-239-0679
Provider Business Practice Location Address Fax Number:
423-239-0673
Provider Enumeration Date:
04/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  8619 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 7018 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8619 . This is a "TENNESSEE PHARMACIST LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7018 . This is a "NC PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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