1225331358 NPI number — MRS. LAURIE CARROLL VARNER RPH

Table of content: MRS. LAURIE CARROLL VARNER RPH (NPI 1225331358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225331358 NPI number — MRS. LAURIE CARROLL VARNER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARNER
Provider First Name:
LAURIE
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
MRS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225331358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 BAYBUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-3181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-847-4781
Provider Business Mailing Address Fax Number:
919-847-4857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8345 CREEDMOOR RD # D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27613-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-848-4191
Provider Business Practice Location Address Fax Number:
919-676-6866
Provider Enumeration Date:
12/11/2010

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:  9375 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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