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General NPI Number Information
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NPI Number | 1629664040
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Entity Type | Individual
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Provider Name | JOSHUA ERIC LOLLER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2020
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Last Update Date | 12/19/2020
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Provider Practice Location Address
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Address Line | 108 E LOCUST ST
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City | MT STERLING
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State | KY
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Zip | 40353-1404
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Country | US
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Telephone | 859-498-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 1052 DUCK HORN DR APT 13
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City | RICHMOND
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State | KY
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Zip | 40475-6578
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Country | US
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Telephone | 423-963-8403
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P9146
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License Number State | ID
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