Provider Demographics
NPI:1760824221
Name:MCCULLOUGH, LORA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 NE ZAC LENTZ PKWY
Mailing Address - Street 2:T-0888
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7608 NE ZAC LENTZ PKWY
Practice Address - Street 2:T-0888
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1390
Practice Address - Country:US
Practice Address - Phone:361-579-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist