Provider Demographics
NPI:1881962629
Name:BEARD, LORI D
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:BEARD
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 1:2500 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3508
Mailing Address - Country:US
Mailing Address - Phone:219-949-1055
Mailing Address - Fax:219-944-7371
Practice Address - Street 1:2500 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3508
Practice Address - Country:US
Practice Address - Phone:219-949-1055
Practice Address - Fax:219-944-7371
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016294A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist