Active NPI
Lori Vaughan Mazsure
- Pharmacist
- Petersburg, VA
National Provider Identifier
1467430751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202205834
- Practice address
- 26317 West Washington Street
Petersburg, VA 23803 - Phone
- (804) 524-7744
- Fax
- (804) 524-4718
- NPI assigned
- Jan 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202205834 | VA | Primary |
Addresses
Primary practice location
26317 West Washington Street
Petersburg, VA 23803
Mailing address
26317 West Washington Street
Petersburg, VA 23803
Phone (804) 524-7744
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49-0104 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202205834 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1467430751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26317 WEST WASHINGTON STREET",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "23803",
"telephone_number": "804-524-7744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26317 WEST WASHINGTON STREET",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "23803",
"telephone_number": "804-524-7744",
"fax_number": "804-524-4718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZSURE",
"first_name": "LORI",
"middle_name": "VAUGHAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-06",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202205834",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "49-0104",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petersburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.