Healthcare Provider Details

I. General information

NPI: 1538562921
Provider Name (Legal Business Name): LYNDIE DANIEL LAXTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 S MAIN ST
WAKE FOREST NC
27587-8817
US

IV. Provider business mailing address

2114 S MAIN ST
WAKE FOREST NC
27587-8817
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-9518
  • Fax: 919-562-9517
Mailing address:
  • Phone: 919-562-9518
  • Fax: 919-562-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: