Provider Demographics
NPI:1922357334
Name:DANCER, LOREN RAE (RPH)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:RAE
Last Name:DANCER
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 1:305 TASMAN PL
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9402
Mailing Address - Country:US
Mailing Address - Phone:541-929-6094
Mailing Address - Fax:541-929-6094
Practice Address - Street 1:12400 HIGH BLUFF DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3077
Practice Address - Country:US
Practice Address - Phone:858-523-6646
Practice Address - Fax:866-580-6378
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist