Healthcare Provider Details

I. General information

NPI: 1487283859
Provider Name (Legal Business Name): LIA STORTS PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30381 CHIEFTAIN DR
LOGAN OH
43138-9092
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-2555
  • Fax: 740-773-4032
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-851-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03438722
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: