Provider Demographics
NPI:1578848164
Name:LOVELL, DAVID L (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:LOVELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10088 GULF CENTER DRIVE
Mailing Address - Street 2:COSTCO PHARMACY 0621
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-433-7249
Mailing Address - Fax:239-433-7246
Practice Address - Street 1:10088 GULF CENTER DRIVE
Practice Address - Street 2:COSTCO PHARMACY 0621
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913
Practice Address - Country:US
Practice Address - Phone:239-433-7249
Practice Address - Fax:239-433-7246
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist