MEDICARE: DR. JESSICA KATHERINE LISKA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28188	TN

General Provider Information

NPI Number	:	1154690832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA KATHERINE LISKA RPH

Provider Business Mailing Address
First Line	:	8024 STAGE HILLS BLVD STE 107
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4048
Country	:	US
Telephone Number	:	800-962-6339
Fax Number	:	866-755-6339

Provider Business Practice Location Address
First Line	:	8024 STAGE HILLS BLVD STE 107
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4048
Country	:	US
Telephone Number	:	800-962-6339
Fax Number	:	866-755-6339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2011
Last Update Date	:	12/24/2011

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