MEDICARE: MS. LISA DENISE CHAMBLEE PHARM.D.

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	8455	AR

General Provider Information

NPI Number	:	1316932643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DENISE CHAMBLEE PHARM.D.

Provider Business Mailing Address
First Line	:	7117 S R ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2701
Country	:	US
Telephone Number	:	479-452-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	6802 ROGERS AVE STE 2
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4010
Country	:	US
Telephone Number	:	479-452-6116
Fax Number	:	479-484-7409

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/12/2012

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