Provider Demographics
NPI:1134585425
Name:MORAN, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MORAN
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 1:405 BOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 BOWER HILL RD
Practice Address - Street 2:
Practice Address - City:VENETIA
Practice Address - State:PA
Practice Address - Zip Code:15367-1308
Practice Address - Country:US
Practice Address - Phone:724-942-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-03
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034511R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist