Provider Demographics
NPI:1649042532
Name:LOTT, JONATHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-5040
Mailing Address - Country:US
Mailing Address - Phone:479-387-6273
Mailing Address - Fax:
Practice Address - Street 1:1311 S WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6284
Practice Address - Country:US
Practice Address - Phone:479-268-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist