Provider Demographics
NPI:1568739530
Name:VELASCO, LORELEI DENURA
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:DENURA
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994A PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-8285
Mailing Address - Country:US
Mailing Address - Phone:530-927-8183
Mailing Address - Fax:
Practice Address - Street 1:16261 HIGHWAY 101 S
Practice Address - Street 2:
Practice Address - City:HARBOR
Practice Address - State:OR
Practice Address - Zip Code:97415-9499
Practice Address - Country:US
Practice Address - Phone:541-469-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist