Provider Demographics
NPI:1811592330
Name:HOUSTON, LORI KITCHENS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KITCHENS
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3655
Mailing Address - Country:US
Mailing Address - Phone:770-435-2178
Mailing Address - Fax:
Practice Address - Street 1:2994 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3655
Practice Address - Country:US
Practice Address - Phone:770-435-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA015511OtherSTATE LICENSE