Provider Demographics
NPI:1962099846
Name:POWELL, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:POWELL
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 1:11420 WATTERSON CT STE 600
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2385
Mailing Address - Country:US
Mailing Address - Phone:502-297-8802
Mailing Address - Fax:855-253-1020
Practice Address - Street 1:11420 WATTERSON CT STE 600
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-2385
Practice Address - Country:US
Practice Address - Phone:502-297-8802
Practice Address - Fax:855-253-1020
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027953A183500000X
KY014112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist