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General NPI Number Information
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NPI Number | 1093090615
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Entity Type | Individual
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Provider Name | LISA HORNER
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Gender | Female
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 958 HAILEY LN
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City | PUEBLO WEST
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State | CO
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Zip | 81007-4438
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Country | US
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Telephone | 719-404-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 958 HAILEY LN
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City | PUEBLO WEST
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State | CO
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Zip | 81007-4438
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Country | US
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Telephone | 719-404-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18129
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3532
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0013046
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S018885
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA.0019362
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License Number State | CO
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