MEDICARE: COREY LOTRIDGE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	39359	TN

General Provider Information

NPI Number	:	1346845591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY LOTRIDGE PHARMD

Provider Business Mailing Address
First Line	:	1010 57TH AVE N
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-1900
Country	:	US
Telephone Number	:	419-302-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 HARDING PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2102
Country	:	US
Telephone Number	:	615-292-0601
Fax Number	:	615-292-3608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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