MEDICARE: MRS. LISA PARAMORE PICKELSIMER

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	19800	FL
2	183500000X	Pharmacist	10435	AL

General Provider Information

NPI Number	:	1225376627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA PARAMORE PICKELSIMER

Provider Business Mailing Address
First Line	:	4041 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2920
Country	:	US
Telephone Number	:	334-260-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 ATLANTA HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2920
Country	:	US
Telephone Number	:	334-260-7788
Fax Number	:

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/27/2013

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