Provider Demographics
NPI:1093606204
Name:THAVICHITH, AVEEDA
Entity type:Individual
Prefix:
First Name:AVEEDA
Middle Name:
Last Name:THAVICHITH
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 1:3602 SUMMEROW RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7103
Mailing Address - Country:US
Mailing Address - Phone:704-956-7625
Mailing Address - Fax:
Practice Address - Street 1:6802 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6204
Practice Address - Country:US
Practice Address - Phone:704-829-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist