=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922391689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA AMPARO FLETCHER PHARMD, BCPS, AAHIVP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2011
-----------------------------------------------------
Last Update Date | 05/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MANNING DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-974-0169
-----------------------------------------------------
Fax | 984-974-4587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 MANNING DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-974-0169
-----------------------------------------------------
Fax | 984-974-4587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 26022817A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 20254
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------