Provider Demographics
NPI:1275171670
Name:GERHOLD, LORI SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SUE
Last Name:GERHOLD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:IA
Mailing Address - Zip Code:52206-4700
Mailing Address - Country:US
Mailing Address - Phone:319-446-6231
Mailing Address - Fax:319-446-6232
Practice Address - Street 1:401 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:IA
Practice Address - Zip Code:52206-4700
Practice Address - Country:US
Practice Address - Phone:319-446-6231
Practice Address - Fax:319-446-6232
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist