Provider Demographics
NPI:1164705026
Name:LOTZ, KAREN THERESA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:THERESA
Last Name:LOTZ
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 1:101 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-7209
Mailing Address - Country:US
Mailing Address - Phone:973-471-2657
Mailing Address - Fax:973-473-1558
Practice Address - Street 1:101 PRESIDENT ST
Practice Address - Street 2:1
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-7209
Practice Address - Country:US
Practice Address - Phone:973-471-2657
Practice Address - Fax:973-473-1558
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01602300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist