Provider Demographics
NPI:1598584112
Name:LORD, AMBER NICOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:LORD
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 1:1851 VERNACI DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6174
Mailing Address - Country:US
Mailing Address - Phone:636-825-7701
Mailing Address - Fax:
Practice Address - Street 1:1851 VERNACI DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-6174
Practice Address - Country:US
Practice Address - Phone:636-825-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024038371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist