Provider Demographics
NPI:1114430584
Name:KREKLAU, LORI ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:KREKLAU
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 1:8265 89TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALSEN
Mailing Address - State:ND
Mailing Address - Zip Code:58311-9271
Mailing Address - Country:US
Mailing Address - Phone:701-682-5506
Mailing Address - Fax:
Practice Address - Street 1:401 COLLEGE DR S
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3501
Practice Address - Country:US
Practice Address - Phone:701-662-2015
Practice Address - Fax:701-662-2055
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH4022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist