Healthcare Provider Details

I. General information

NPI: 1104740364
Provider Name (Legal Business Name): LORI WEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 S ROLLING RIDGE DR
SAINT ANTHONY IN
47575-9632
US

IV. Provider business mailing address

4273 S ROLLING RIDGE DR
SAINT ANTHONY IN
47575-9632
US

V. Phone/Fax

Practice location:
  • Phone: 812-631-8003
  • Fax:
Mailing address:
  • Phone: 812-631-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019300A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: