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General NPI Number Information
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NPI Number | 1730172446
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Entity Type | Individual
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Provider Name | LORI NOEL CLEMMENS-FUNKE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 NORTH AVE
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3307
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Country | US
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Telephone | 269-964-5852
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Fax |
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Provider Business Mailing Address
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Address Line | 20361 PINE LAKE RD
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City | BATTLE CREEK
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State | MI
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Zip | 49014-8111
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Country | US
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Telephone | 269-966-9185
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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 | 5302034501
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License Number State | MI
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