Healthcare Provider Details

I. General information

NPI: 1790407773
Provider Name (Legal Business Name): PATRICIA LOURO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 RIVER ST
PALATKA FL
32177-5042
US

IV. Provider business mailing address

400 CHAMBERLAIN DR
ST AUGUSTINE FL
32086-4140
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-0558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: