MEDICARE: LISA SELVEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20220	NC
2	183500000X	Pharmacist	6812	SC

General Provider Information

NPI Number	:	1093155467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SELVEY RPH

Provider Business Mailing Address
First Line	:	1605 NEW GARDEN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2001
Country	:	US
Telephone Number	:	336-855-6949
Fax Number	:	336-855-3529

Provider Business Practice Location Address
First Line	:	1605 NEW GARDEN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2001
Country	:	US
Telephone Number	:	336-855-6949
Fax Number	:	336-855-3529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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