Provider Demographics
NPI:1598197899
Name:MARION, LUKE LAZARUS (RPH)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:LAZARUS
Last Name:MARION
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2301
Mailing Address - Country:US
Mailing Address - Phone:336-724-7491
Mailing Address - Fax:336-724-7694
Practice Address - Street 1:2221 CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2301
Practice Address - Country:US
Practice Address - Phone:336-724-7491
Practice Address - Fax:336-724-9674
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist