Provider Demographics
NPI:1659583532
Name:PROFIT, LORI DEANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DEANN
Last Name:PROFIT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DEANN
Other - Last Name:LICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1433
Mailing Address - Country:US
Mailing Address - Phone:989-672-4482
Mailing Address - Fax:
Practice Address - Street 1:4005 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist