Provider Demographics
NPI:1508008160
Name:ARCHER, LORI W (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:W
Last Name:ARCHER
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 1:321 AYLESBURY LN
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-9101
Mailing Address - Country:US
Mailing Address - Phone:478-552-8569
Mailing Address - Fax:
Practice Address - Street 1:321 AYLESBURY LN
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-9101
Practice Address - Country:US
Practice Address - Phone:478-552-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist