Provider Demographics
NPI:1558647065
Name:VANDERMEER, LORI KIMBERLEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KIMBERLEY
Last Name:VANDERMEER
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 1:3047 W ALBAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9553
Mailing Address - Country:US
Mailing Address - Phone:734-457-4326
Mailing Address - Fax:734-457-4326
Practice Address - Street 1:484 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1612
Practice Address - Country:US
Practice Address - Phone:734-240-2954
Practice Address - Fax:734-240-2960
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist