Provider Demographics
NPI:1073893764
Name:DONNELLY, LORI R (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:R
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13370 WALNUT TRCE
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9350
Mailing Address - Country:US
Mailing Address - Phone:440-564-9495
Mailing Address - Fax:
Practice Address - Street 1:501 WATER ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1146
Practice Address - Country:US
Practice Address - Phone:440-286-4167
Practice Address - Fax:440-285-3141
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist