Healthcare Provider Details

I. General information

NPI: 1043312416
Provider Name (Legal Business Name): CAROLYN LOTT FLORENCE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN LOTT FLORENCE RPH

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 WEST PATTON ST
LAFAYETTE GA
30728-0791
US

IV. Provider business mailing address

PO BOX 791
LA FAYETTE GA
30728-0791
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-3114
  • Fax: 706-638-7713
Mailing address:
  • Phone: 706-638-3114
  • Fax: 706-638-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11833
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: