MEDICARE: MARCIA MICHELLE BLACKMON LEVERIS PHARMD

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	23294	NC

General Provider Information

NPI Number	:	1891129631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA MICHELLE BLACKMON LEVERIS PHARMD

Provider Business Mailing Address
First Line	:	279 ZACKS MILL RD
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-6881
Country	:	US
Telephone Number	:	919-291-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 FAYETTEVILLE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3614
Country	:	US
Telephone Number	:	919-772-2640
Fax Number	:

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

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	04/22/2016

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