MEDICARE: LORI KNEISLY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03316946	OH

General Provider Information

NPI Number	:	1104808526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI KNEISLY RPH

Provider Business Mailing Address
First Line	:	3500 N WAGGONER RD
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 N WAGGONER RD
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8567
Country	:	US
Telephone Number	:	614-939-5807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	07/08/2007

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Directions to “ LORI KNEISLY RPH” Practice Location

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