Provider Demographics
NPI:1972128908
Name:IRWIN, LORI DAWN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DAWN
Last Name:IRWIN
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 1:163 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-8088
Mailing Address - Country:US
Mailing Address - Phone:712-210-2462
Mailing Address - Fax:
Practice Address - Street 1:1831 LAKE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-7606
Practice Address - Country:US
Practice Address - Phone:712-732-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist