Provider Demographics
NPI:1104107952
Name:WHITACRE, LORA ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:ELIZABETH
Last Name:WHITACRE
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 1:4203 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8867
Mailing Address - Country:US
Mailing Address - Phone:479-866-3172
Mailing Address - Fax:
Practice Address - Street 1:1722 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3324
Practice Address - Country:US
Practice Address - Phone:479-246-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR9807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist