Provider Demographics
NPI:1861693988
Name:KEARNEY, LORI JEAN (RPH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:KEARNEY
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 1:760 CHERRY GULCH RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6471
Mailing Address - Country:US
Mailing Address - Phone:970-247-8016
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE LN UNIT 111
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7490
Practice Address - Country:US
Practice Address - Phone:970-375-7711
Practice Address - Fax:970-375-7722
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12196Other183500000X