Provider Demographics
NPI:1952640336
Name:LOMELI, LAURIE KAY
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:KAY
Last Name:LOMELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 GIBSON BLVD BLDG 20176
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87117-0001
Mailing Address - Country:US
Mailing Address - Phone:505-846-7902
Mailing Address - Fax:
Practice Address - Street 1:7901 GIBSON BLVD BLDG 20176
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87117-0001
Practice Address - Country:US
Practice Address - Phone:505-846-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15929183500000X
NMRP00008125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist