=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275893059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. LORI SENDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2012
-----------------------------------------------------
Last Update Date | 05/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7823 BERGENLINE AVE
-----------------------------------------------------
City | NORTH BERGEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07047-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-869-1235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 427 PAGE TER
-----------------------------------------------------
City | SOUTH ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07079-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-763-5340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28R103479500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------