Provider Demographics
NPI:1093925570
Name:PAULSEN, LORI A
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PAULSEN
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 1:1305 PHEASANT VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-8652
Mailing Address - Country:US
Mailing Address - Phone:319-338-8319
Mailing Address - Fax:
Practice Address - Street 1:655 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:888-823-0923
Practice Address - Fax:866-486-7248
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist