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NPI Code Detail

MEDICARE: MRS. LISA JOAN DEVRIES R.P.

MEDICARE: MRS. LISA JOAN DEVRIES R.P.
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
1183500000XPharmacist10449NE

General Provider Information

NPI Number : 1588931588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA JOAN DEVRIES R.P.
Provider Business Mailing Address
First Line : 1844 WASHINGTON ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-2553
Country : US
Telephone Number : 402-474-4555
Fax Number :
Provider Business Practice Location Address
First Line : 1701 SOUTH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-2734
Country : US
Telephone Number : 402-435-3271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2011
Last Update Date : 11/19/2011

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