Provider Demographics
NPI:1679185789
Name:DOUGHERTY, LORI LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:DOUGHERTY
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 1:115 SALTVILLE CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-1207
Mailing Address - Country:US
Mailing Address - Phone:610-509-7344
Mailing Address - Fax:
Practice Address - Street 1:806 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-4426
Practice Address - Country:US
Practice Address - Phone:931-728-0874
Practice Address - Fax:931-728-7318
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist