Healthcare Provider Details

I. General information

NPI: 1124400148
Provider Name (Legal Business Name): LISA ANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E FAIRVIEW AVE
MERIDIAN ID
83642-5702
US

IV. Provider business mailing address

1850 E FAIRVIEW AVE
MERIDIAN ID
83642-5702
US

V. Phone/Fax

Practice location:
  • Phone: 208-887-5273
  • Fax:
Mailing address:
  • Phone: 208-887-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7268
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: