Provider Demographics
NPI:1063762425
Name:LAFAVOR, NANCY N (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:N
Last Name:LAFAVOR
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:PO BOX 1745
Mailing Address - Street 2:62 VAN HORN
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-1745
Mailing Address - Country:US
Mailing Address - Phone:912-786-5642
Mailing Address - Fax:912-898-5383
Practice Address - Street 1:150 JOHNNY MERCER BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410
Practice Address - Country:US
Practice Address - Phone:912-897-3220
Practice Address - Fax:912-898-5383
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist