Healthcare Provider Details
I. General information
NPI: 1215181433
Provider Name (Legal Business Name): LISA M KARSTEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7802 VILLA NOVA DR
BOCA RATON FL
33433-1027
US
IV. Provider business mailing address
7802 VILLA NOVA DR
BOCA RATON FL
33433-1027
US
V. Phone/Fax
- Phone: 561-750-3435
- Fax:
- Phone: 561-750-3435
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 183500000X |
| Taxonomy | Pharmacist |
| License Number | PS26245 |
| License Number State | FL |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1835G0303X |
| Taxonomy | Geriatric Pharmacist |
| License Number | PU5388 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: