Provider Demographics
NPI:1760098404
Name:MCWHORTER LOUX, LISA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MCWHORTER LOUX
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 1:57 EXECUTIVE PARK S STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2249
Mailing Address - Country:US
Mailing Address - Phone:770-330-7501
Mailing Address - Fax:
Practice Address - Street 1:57 EXECUTIVE PARK S STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2249
Practice Address - Country:US
Practice Address - Phone:770-330-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist