Provider Demographics
NPI:1033401336
Name:CATHEY, LORI CLARK (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:CLARK
Last Name:CATHEY
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 1:1140 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2204
Mailing Address - Country:US
Mailing Address - Phone:850-729-2239
Mailing Address - Fax:
Practice Address - Street 1:1140 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2204
Practice Address - Country:US
Practice Address - Phone:850-729-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25471183500000X
AL11861183500000X
AK1352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist