Provider Demographics
NPI:1023636867
Name:CLOUSE, LENA DANIELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:LENA
Middle Name:DANIELLE
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8675
Mailing Address - Country:US
Mailing Address - Phone:219-771-0102
Mailing Address - Fax:
Practice Address - Street 1:GENOA HEALTHCARE LLC
Practice Address - Street 2:8555 TAFT STREET
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-769-8171
Practice Address - Fax:219-769-8176
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022500A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist