Provider Demographics
NPI:1801102934
Name:LOTZ, LAURA (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOTZ
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 1:4455 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4934
Mailing Address - Country:US
Mailing Address - Phone:760-943-9423
Mailing Address - Fax:760-943-9492
Practice Address - Street 1:4455 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4934
Practice Address - Country:US
Practice Address - Phone:760-943-9423
Practice Address - Fax:760-943-9492
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist