Healthcare Provider Details

I. General information

NPI: 1700997202
Provider Name (Legal Business Name): LORI SPELLMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

10280 CLUBHOUSE TURN RD
LAKE WORTH FL
33467-5454
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-6962
  • Fax: 561-422-5378
Mailing address:
  • Phone: 561-967-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS27116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: