Provider Demographics
NPI:1043589617
Name:DOTTEN, LORI LEA
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEA
Last Name:DOTTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 SW COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5719
Mailing Address - Country:US
Mailing Address - Phone:352-873-9806
Mailing Address - Fax:352-873-8766
Practice Address - Street 1:4747 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5719
Practice Address - Country:US
Practice Address - Phone:352-873-9806
Practice Address - Fax:352-873-8766
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist