Healthcare Provider Details

I. General information

NPI: 1013402619
Provider Name (Legal Business Name): BIANCA XIOMARA LASCANO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CLOVERDALE AVE
WINSTON SALEM NC
27103-2506
US

IV. Provider business mailing address

4000 CLUBHOUSE CT APT 2G
HIGH POINT NC
27265-8194
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-0561
  • Fax:
Mailing address:
  • Phone: 757-284-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberNA
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: