Provider Demographics
NPI:1003281239
Name:NEKOTA, LORI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:NEKOTA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 FORESTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6611
Mailing Address - Country:US
Mailing Address - Phone:714-969-2412
Mailing Address - Fax:714-969-1322
Practice Address - Street 1:6242 FORESTER DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6611
Practice Address - Country:US
Practice Address - Phone:714-969-2412
Practice Address - Fax:714-969-1322
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist