Healthcare Provider Details

I. General information

NPI: 1215533302
Provider Name (Legal Business Name): KENDRA LOTT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 LOUDON RD
CONCORD NH
03301-5610
US

IV. Provider business mailing address

157 LOUDON RD
CONCORD NH
03301-5610
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-0793
  • Fax:
Mailing address:
  • Phone: 603-225-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHCY-01104
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: