Provider Demographics
NPI:1538792296
Name:MCQUEEN, LORA (RPH)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 LAURIE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-2418
Mailing Address - Country:US
Mailing Address - Phone:417-259-4364
Mailing Address - Fax:
Practice Address - Street 1:2100 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-2438
Practice Address - Country:US
Practice Address - Phone:417-926-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist