Provider Demographics
NPI:1194155267
Name:LOTTER, THOMAS SR (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:LOTTER
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1423
Mailing Address - Country:US
Mailing Address - Phone:920-604-0058
Mailing Address - Fax:
Practice Address - Street 1:126 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-9446
Practice Address - Country:US
Practice Address - Phone:920-834-5251
Practice Address - Fax:920-834-9801
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist