=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598354243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA LESHER HEROLD PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2021
-----------------------------------------------------
Last Update Date | 01/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 E STADIUM
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71753-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-234-7292
-----------------------------------------------------
Fax | 870-234-4443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E STADIUM
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71753-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-234-7292
-----------------------------------------------------
Fax | 870-234-4443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PD10185
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------