Provider Demographics
NPI:1659776219
Name:LOR, DOUANGDARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOUANGDARA
Middle Name:
Last Name:LOR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1456
Mailing Address - Country:US
Mailing Address - Phone:559-719-2204
Mailing Address - Fax:559-719-2214
Practice Address - Street 1:1363 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1456
Practice Address - Country:US
Practice Address - Phone:559-719-2204
Practice Address - Fax:559-719-2214
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist