Provider Demographics
NPI:1811378789
Name:AMBORN, LORI MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:AMBORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-726-2890
Mailing Address - Fax:651-726-2848
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-726-2890
Practice Address - Fax:651-726-2848
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116533OtherPHARMACIST LICENSE
MN116533OtherPRECEPTOR LICENSE