Healthcare Provider Details

I. General information

NPI: 1922373174
Provider Name (Legal Business Name): LISA SMITH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MARTIN LUTHER KING JR. HWY
ROSEBORO NC
28382
US

IV. Provider business mailing address

35 MYRTLE AVE
ELIZABETHTOWN NC
28337-6221
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-5100
  • Fax:
Mailing address:
  • Phone: 919-820-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11037
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: