Provider Demographics
NPI:1104101690
Name:LOTT, JARED ALAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ALAN
Last Name:LOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CHARLIE WATTS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157
Mailing Address - Country:US
Mailing Address - Phone:770-443-4886
Mailing Address - Fax:770-443-5904
Practice Address - Street 1:303 CHARLIE WATTS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:770-443-4886
Practice Address - Fax:770-443-5904
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1161568OtherNABP
1386930071OtherNPI