Provider Demographics
NPI:1386944668
Name:LINGERFELT, MARK GORDON (DPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:GORDON
Last Name:LINGERFELT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9025 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8448
Mailing Address - Country:US
Mailing Address - Phone:901-383-2265
Mailing Address - Fax:901-386-8476
Practice Address - Street 1:9025 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8448
Practice Address - Country:US
Practice Address - Phone:901-371-0411
Practice Address - Fax:901-383-4808
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4390183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist