Individual
LORI VAUGHAN MAZSURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26317 WEST WASHINGTON STREET, PETERSBURG, VA 23803
(804) 524-7744
(804) 524-4718
Mailing address
26317 WEST WASHINGTON STREET, PETERSBURG, VA 23803
(804) 524-7744
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202205834
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49-0104
—
VA
Enumeration date
01/06/2006
Last updated
12/06/2011
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