Provider Demographics
NPI:1821013624
Name:NAM, LORI MIJONG (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:LORI
Middle Name:MIJONG
Last Name:NAM
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 1:11516 BELVEDERE VISTA LN
Mailing Address - Street 2:#201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4350
Mailing Address - Country:US
Mailing Address - Phone:240-350-7033
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:(652-119F)
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022072171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy