Provider Demographics
NPI:1346823846
Name:ELDRED, LORI ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:ELDRED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:CANAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2902 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2661
Mailing Address - Country:US
Mailing Address - Phone:812-478-1006
Mailing Address - Fax:812-478-9296
Practice Address - Street 1:2902 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2661
Practice Address - Country:US
Practice Address - Phone:812-478-1006
Practice Address - Fax:812-478-9296
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018562A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist