Provider Demographics
NPI:1225246424
Name:BLOSSER-MILTON, LORI A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:BLOSSER-MILTON
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 1:11720 COLLINWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7115
Mailing Address - Country:US
Mailing Address - Phone:540-785-2659
Mailing Address - Fax:540-785-2659
Practice Address - Street 1:4250 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4806
Practice Address - Country:US
Practice Address - Phone:540-785-4721
Practice Address - Fax:540-785-6601
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist