Healthcare Provider Details

I. General information

NPI: 1962725978
Provider Name (Legal Business Name): LISA BETH PRITCHETT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 HIGHWAY 190
MANDEVILLE LA
70471-3298
US

IV. Provider business mailing address

1460 ANNUNCIATION ST #6107
NEW ORLEANS LA
70130-8605
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-8106
  • Fax: 985-624-5405
Mailing address:
  • Phone: 518-669-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038854
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19377
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: