Provider Demographics
NPI:1902407281
Name:FOGARTY, LORI ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:FOGARTY
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 1:4205 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3800
Mailing Address - Country:US
Mailing Address - Phone:765-446-1278
Mailing Address - Fax:
Practice Address - Street 1:4205 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-3800
Practice Address - Country:US
Practice Address - Phone:765-446-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019225A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist