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General NPI Number Information
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NPI Number | 1689981425
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Entity Type | Individual
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Provider Name | LISA R DYSARD PHARM D
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Gender | Female
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 1035 E WILCOX AVE
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City | WHITE CLOUD
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State | MI
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Zip | 49349-8794
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Country | US
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Telephone | 231-689-7156
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Fax | 231-689-3869
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Provider Business Mailing Address
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Address Line | 19592 PARK RD
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City | BIG RAPIDS
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State | MI
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Zip | 49307-9443
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Country | US
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Telephone | 231-679-0399
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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 | 5302038159
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License Number State | MI
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