Provider Demographics
NPI:1164991527
Name:WINEMAN, LORI M (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:WINEMAN
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:MI
Mailing Address - Zip Code:49709-0850
Mailing Address - Country:US
Mailing Address - Phone:989-785-4855
Mailing Address - Fax:989-785-2267
Practice Address - Street 1:11899 M 32
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709-9374
Practice Address - Country:US
Practice Address - Phone:989-785-4855
Practice Address - Fax:989-785-2267
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid