Provider Demographics
NPI:1861788614
Name:LORENZO, LOURDES M
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:LORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3184
Mailing Address - Country:US
Mailing Address - Phone:352-742-2966
Mailing Address - Fax:
Practice Address - Street 1:684 E HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3184
Practice Address - Country:US
Practice Address - Phone:352-242-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49560183500000X
PR4446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist