Provider Demographics
NPI:1679102487
Name:KIZIAH, LAUREN ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:KIZIAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 FAIRGROVE CHURCH RD SE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8609
Mailing Address - Country:US
Mailing Address - Phone:828-322-4505
Mailing Address - Fax:
Practice Address - Street 1:815 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8609
Practice Address - Country:US
Practice Address - Phone:828-322-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist