Provider Demographics
NPI:1689960965
Name:STROM, LONNIE JAMES
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:JAMES
Last Name:STROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GRAND MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5085
Mailing Address - Country:US
Mailing Address - Phone:407-301-8912
Mailing Address - Fax:
Practice Address - Street 1:315 GRAND MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5085
Practice Address - Country:US
Practice Address - Phone:407-301-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS40774Medicaid