MEDICARE: MRS. LISA MOIRA DENMARK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20150	MA

General Provider Information

NPI Number	:	1144507658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MOIRA DENMARK RPH

Provider Business Mailing Address
First Line	:	PO BOX 1315
Second Line	:
City	:	N FALMOUTH
State	:	MA
Zip	:	02556-1315
Country	:	US
Telephone Number	:	508-564-4459
Fax Number	:	508-564-6172

Provider Business Practice Location Address
First Line	:	111 COUNTY RD
Second Line	:
City	:	N FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	508-564-4459
Fax Number	:	508-564-6172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	11/11/2011

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