Provider Demographics
NPI:1174894216
Name:HOCKENBERRY, LORI ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:HOCKENBERRY
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 1:3022 S JIOVANNI AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7955
Mailing Address - Country:US
Mailing Address - Phone:208-283-2294
Mailing Address - Fax:
Practice Address - Street 1:4924 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2821
Practice Address - Country:US
Practice Address - Phone:208-336-1728
Practice Address - Fax:208-336-1971
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist