Provider Demographics
NPI:1356651665
Name:THOMAS, LORI JO
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3438
Mailing Address - Country:US
Mailing Address - Phone:724-863-3700
Mailing Address - Fax:
Practice Address - Street 1:328 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3438
Practice Address - Country:US
Practice Address - Phone:724-863-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034887L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist