Provider Demographics
NPI:1659941862
Name:LOTUSRX
Entity Type:Organization
Organization Name:LOTUSRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAVO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-313-3380
Mailing Address - Street 1:1411 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2637
Mailing Address - Country:US
Mailing Address - Phone:770-313-3380
Mailing Address - Fax:
Practice Address - Street 1:3492 WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-5608
Practice Address - Country:US
Practice Address - Phone:770-313-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy