Healthcare Provider Details

I. General information

NPI: 1467586800
Provider Name (Legal Business Name): LISA ELIZABETH MARCILLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N PENNSYLVANIA AVE
ROSWELL NM
88201-5049
US

IV. Provider business mailing address

1204 N PENNSYLVANIA AVE
ROSWELL NM
88201-5049
US

V. Phone/Fax

Practice location:
  • Phone: 505-627-6915
  • Fax: 505-627-2290
Mailing address:
  • Phone: 505-627-6915
  • Fax: 505-627-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006781
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRP00006781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: