Provider Demographics
NPI:1972789279
Name:PASSE, LORI JEAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:PASSE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MAIN STREET WEST
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981
Mailing Address - Country:US
Mailing Address - Phone:651-560-4355
Mailing Address - Fax:
Practice Address - Street 1:160 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1237
Practice Address - Country:US
Practice Address - Phone:651-560-4355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist