Provider Demographics
NPI:1205473055
Name:LOVELY, ALICIA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:LOVELY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W HIVELY AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-2113
Mailing Address - Country:US
Mailing Address - Phone:574-294-6092
Mailing Address - Fax:574-294-6102
Practice Address - Street 1:130 W HIVELY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2113
Practice Address - Country:US
Practice Address - Phone:574-294-6092
Practice Address - Fax:574-294-6102
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023220A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist