Provider Demographics
NPI:1164637393
Name:BLOSS-GIRSCH, LORA C
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:C
Last Name:BLOSS-GIRSCH
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 1:316 E LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:MO
Mailing Address - Zip Code:64471
Mailing Address - Country:US
Mailing Address - Phone:660-425-2465
Mailing Address - Fax:
Practice Address - Street 1:2600 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2701
Practice Address - Country:US
Practice Address - Phone:660-425-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007004550183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician