Provider Demographics
NPI:1629664040
Name:LOLLER, JOSHUA ERIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ERIC
Last Name:LOLLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 DUCK HORN DR APT 13
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6578
Mailing Address - Country:US
Mailing Address - Phone:423-963-8403
Mailing Address - Fax:
Practice Address - Street 1:108 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1404
Practice Address - Country:US
Practice Address - Phone:859-498-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist