Provider Demographics
NPI:1184701070
Name:GOLTERMAN, LORI J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:GOLTERMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9624 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1506
Mailing Address - Country:US
Mailing Address - Phone:202-273-8429
Mailing Address - Fax:202-273-9067
Practice Address - Street 1:9624 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1506
Practice Address - Country:US
Practice Address - Phone:202-273-8429
Practice Address - Fax:202-273-9067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X, 1835G0303X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy