Provider Demographics
NPI:1558931535
Name:LOWELL, LAMAR
Entity Type:Individual
Prefix:
First Name:LAMAR
Middle Name:
Last Name:LOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E RIVERSIDE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6865
Mailing Address - Country:US
Mailing Address - Phone:208-367-4260
Mailing Address - Fax:208-938-2137
Practice Address - Street 1:323 E RIVERSIDE DR STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6865
Practice Address - Country:US
Practice Address - Phone:208-367-4260
Practice Address - Fax:208-938-2137
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist