Provider Demographics
NPI:1578951687
Name:POORE, LORI (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:POORE
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 1:27520 COVINGTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-9100
Mailing Address - Country:US
Mailing Address - Phone:253-796-1011
Mailing Address - Fax:253-796-1008
Practice Address - Street 1:27520 COVINGTON WAY SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-9100
Practice Address - Country:US
Practice Address - Phone:253-796-1011
Practice Address - Fax:253-796-1008
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist