MEDICARE: LISA RENEE FISANICH PHARM.D.

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	RP044352L	PA

General Provider Information

NPI Number	:	1255437364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE FISANICH PHARM.D.

Provider Business Mailing Address
First Line	:	106 ADAMS CIR
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-2334
Country	:	US
Telephone Number	:	724-349-5347
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 WASHINGTON ST
Second Line	:
City	:	SALTSBURG
State	:	PA
Zip	:	15681-1131
Country	:	US
Telephone Number	:	724-639-9022
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/30/2020

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