Healthcare Provider Details

I. General information

NPI: 1053431049
Provider Name (Legal Business Name): LISA LEE SMITH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N MAIN ST SUITE D
WILLIAMSTOWN KY
41097-8502
US

IV. Provider business mailing address

1355 DRY RIDGE MOUNT ZION RD
DRY RIDGE KY
41035-7674
US

V. Phone/Fax

Practice location:
  • Phone: 859-823-0200
  • Fax: 859-823-4500
Mailing address:
  • Phone: 859-824-9964
  • Fax: 859-823-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010281
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: