Healthcare Provider Details

I. General information

NPI: 1831979640
Provider Name (Legal Business Name): KSENIA ZHURAVLEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RAEFORD RD
FAYETTEVILLE NC
28304-2862
US

IV. Provider business mailing address

19 HEATHERWOOD DR
LILLINGTON NC
27546-5551
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-0058
  • Fax:
Mailing address:
  • Phone: 423-747-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32609
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: