Provider Demographics
NPI:1831460005
Name:KRUSE, LORI SUE (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SUE
Last Name:KRUSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WOLFE LN
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-1259
Mailing Address - Country:US
Mailing Address - Phone:610-603-9005
Mailing Address - Fax:
Practice Address - Street 1:525 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1080
Practice Address - Country:US
Practice Address - Phone:610-373-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044931T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist