Healthcare Provider Details

I. General information

NPI: 1609160050
Provider Name (Legal Business Name): LISA COTTER PHARM-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOLT GARRISON PKWY
DANVILLE VA
24540-5947
US

IV. Provider business mailing address

155 HOLT GARRISON PKWY
DANVILLE VA
24540-5947
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-9951
  • Fax: 434-799-9961
Mailing address:
  • Phone: 434-799-9951
  • Fax: 434-799-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: