Provider Demographics
NPI:1992078562
Name:WOOLETT, LORI L (CPHT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:WOOLETT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WILLAKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4805
Mailing Address - Country:US
Mailing Address - Phone:541-687-7613
Mailing Address - Fax:
Practice Address - Street 1:2510 WILLAKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4805
Practice Address - Country:US
Practice Address - Phone:541-687-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT0000928183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician