Provider Demographics
NPI:1467727164
Name:LOTT, JESSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S Y SQ
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1739
Mailing Address - Country:US
Mailing Address - Phone:731-645-6100
Mailing Address - Fax:731-645-4333
Practice Address - Street 1:103 S Y SQ
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1739
Practice Address - Country:US
Practice Address - Phone:731-645-6100
Practice Address - Fax:731-645-4333
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist