Provider Demographics
NPI:1033551791
Name:LORENZI, TARA RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:RAE
Last Name:LORENZI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RAE
Other - Last Name:WEGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4647 PROMENADE WAY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2981
Mailing Address - Country:US
Mailing Address - Phone:708-898-5008
Mailing Address - Fax:
Practice Address - Street 1:4647 PROMENADE WAY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2981
Practice Address - Country:US
Practice Address - Phone:708-898-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295896183500000X
IN26024899A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist