Provider Demographics
NPI:1174885487
Name:LENTS, LORETTA (PHARMD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:LENTS
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 1:11 S KINGSHIGHWAY ST STE 61
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5742
Mailing Address - Country:US
Mailing Address - Phone:573-334-2887
Mailing Address - Fax:573-334-1342
Practice Address - Street 1:11 S KINGSHIGHWAY ST STE 61
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5742
Practice Address - Country:US
Practice Address - Phone:573-334-2887
Practice Address - Fax:573-334-1342
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist