Provider Demographics
NPI:1114359650
Name:RADLEY, LAUREN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RADLEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3412
Mailing Address - Country:US
Mailing Address - Phone:919-876-5600
Mailing Address - Fax:
Practice Address - Street 1:3914 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3412
Practice Address - Country:US
Practice Address - Phone:919-876-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234807183500000X
NJ28RI03635800183500000X
CTPCT.0012664183500000X
NC29444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist