Provider Demographics
NPI:1134606288
Name:MCKEOWN, LORI ANN
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:MCKEOWN
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 1:50 BOULDER WAY
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9442
Mailing Address - Country:US
Mailing Address - Phone:207-286-9562
Mailing Address - Fax:207-286-9576
Practice Address - Street 1:50 BOULDER WAY
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9442
Practice Address - Country:US
Practice Address - Phone:207-286-9562
Practice Address - Fax:207-286-9576
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist