Provider Demographics
NPI:1407880560
Name:DEVITO, LORI ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:DEVITO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:182 S BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8020
Mailing Address - Country:US
Mailing Address - Phone:907-262-8737
Mailing Address - Fax:907-260-7405
Practice Address - Street 1:182 S BIRCH ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8020
Practice Address - Country:US
Practice Address - Phone:907-262-8737
Practice Address - Fax:907-260-7405
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH0246Medicaid
AKMS1723Medicaid
AK0615290001Medicare NSC