Provider Demographics
NPI:1154604619
Name:WHITEMAN, LORI L (RPH)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:WHITEMAN
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 1:11200 W RIVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9412
Mailing Address - Country:US
Mailing Address - Phone:765-215-5293
Mailing Address - Fax:
Practice Address - Street 1:3250 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5540
Practice Address - Country:US
Practice Address - Phone:765-287-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist