=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770167611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISHA LYNN BIKLE CPHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2021
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 CHASE SIX BLVD
-----------------------------------------------------
City | BOONSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21713-2059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-432-3953
-----------------------------------------------------
Fax | 301-432-3955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 LANAFIELD DR
-----------------------------------------------------
City | BOONSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21713-1111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-667-2406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | T01574
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------