Provider Demographics
NPI:1760672232
Name:LOTHARY, CHAD ALLEN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALLEN
Last Name:LOTHARY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13987 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2943
Mailing Address - Country:US
Mailing Address - Phone:314-229-4424
Mailing Address - Fax:
Practice Address - Street 1:13987 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2943
Practice Address - Country:US
Practice Address - Phone:314-229-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022476183500000X
IL051.293120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist