Provider Demographics
NPI:1992300396
Name:NEELY, LORI (PHARM D)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:CAVERLY
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1011 GLEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 S GUILD AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3170
Practice Address - Country:US
Practice Address - Phone:707-769-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist