Provider Demographics
NPI:1528329638
Name:ANGELINI, LORA (PHARMD)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:ANGELINI
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:PO BOX 2506
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-2506
Mailing Address - Country:US
Mailing Address - Phone:912-786-7878
Mailing Address - Fax:912-786-7774
Practice Address - Street 1:303 1ST ST
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328-8752
Practice Address - Country:US
Practice Address - Phone:912-786-7878
Practice Address - Fax:912-786-7774
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0254381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist