Active NPI
Michelle Kristine Lastovica, PHARMD
- Pharmacist
- Raleigh, NC
National Provider Identifier
1679841100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19860
- Practice address
- 3201 Edwards Mill Rd Ste 123
Raleigh, NC 27612-5370 - Phone
- (919) 781-2314
- Fax
- (919) 786-1326
- NPI assigned
- Dec 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 19860 | NC | Primary |
Addresses
Primary practice location
3201 Edwards Mill Rd Ste 123
Raleigh, NC 27612-5370
Mailing address
1400 Medfield Rd
Raleigh, NC 27607-4722
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19860 | NC | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harris Teeter LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1679841100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 MEDFIELD RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276074722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 EDWARDS MILL RD STE 123",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276125370",
"telephone_number": "919-781-2314",
"fax_number": "919-786-1326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LASTOVICA",
"first_name": "MICHELLE",
"middle_name": "KRISTINE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-12",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "19860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.