Provider Demographics
NPI:1861520439
Name:LORD, LORI J (RPH)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:J
Last Name:LORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-1605
Mailing Address - Country:US
Mailing Address - Phone:860-889-7803
Mailing Address - Fax:
Practice Address - Street 1:213 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3801
Practice Address - Country:US
Practice Address - Phone:860-889-9857
Practice Address - Fax:860-886-0950
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist