Healthcare Provider Details

I. General information

NPI: 1699260729
Provider Name (Legal Business Name): LISA KOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 07/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

939 NW 79TH TER
PLANTATION FL
33324-1472
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4669
  • Fax:
Mailing address:
  • Phone: 954-452-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS45370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: