Provider Demographics
NPI:1962464925
Name:HOFFMAN, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HOFFMAN
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 1:162 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:IA
Mailing Address - Zip Code:52216-9329
Mailing Address - Country:US
Mailing Address - Phone:563-452-4278
Mailing Address - Fax:
Practice Address - Street 1:124 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1731
Practice Address - Country:US
Practice Address - Phone:563-886-2158
Practice Address - Fax:563-886-1233
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist