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General NPI Number Information
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NPI Number | 1679185789
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Entity Type | Individual
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Provider Name | LORI LYNN DOUGHERTY RPH
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Gender | Female
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 806 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-4426
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Country | US
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Telephone | 931-728-0874
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Fax | 931-728-7318
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Provider Business Mailing Address
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Address Line | 115 SALTVILLE CT
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City | SMYRNA
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State | TN
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Zip | 37167-1207
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Country | US
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Telephone | 610-509-7344
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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 | 41955
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License Number State | TN
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