=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962725978
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA BETH PRITCHETT RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2010
-----------------------------------------------------
Last Update Date | 09/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2915 HIGHWAY 190
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70471-3298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-8106
-----------------------------------------------------
Fax | 985-624-5405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1460 ANNUNCIATION ST #6107
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70130-8605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-669-1888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 038854
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 19377
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------