Provider Demographics
NPI:1376854927
Name:FOX, LORI MIRANDA (PHARMD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MIRANDA
Last Name:FOX
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 1:2151 N CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6749
Mailing Address - Country:US
Mailing Address - Phone:865-457-1377
Mailing Address - Fax:865-457-1327
Practice Address - Street 1:2151 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6749
Practice Address - Country:US
Practice Address - Phone:865-457-1377
Practice Address - Fax:865-457-1327
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist