Provider Demographics
NPI:1164838652
Name:KODIKARA, LORI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:KODIKARA
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 1:1876 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097-7700
Mailing Address - Country:US
Mailing Address - Phone:704-781-0574
Mailing Address - Fax:704-781-0575
Practice Address - Street 1:1876 MAIN ST W
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-7700
Practice Address - Country:US
Practice Address - Phone:704-781-0574
Practice Address - Fax:704-781-0575
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist