MEDICARE: LISA LEVANDER

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	16453	NE

General Provider Information

NPI Number	:	1255934154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LEVANDER

Provider Business Mailing Address
First Line	:	312 E ERIE ST APT 3
Second Line	:
City	:	MISSOURI VALLEY
State	:	IA
Zip	:	51555-1660
Country	:	US
Telephone Number	:	402-741-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 E ERIE ST
Second Line	:
City	:	MISSOURI VALLEY
State	:	IA
Zip	:	51555-1619
Country	:	US
Telephone Number	:	712-642-2747
Fax Number	:

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

Provider Enumeration Date	:	11/21/2020
Last Update Date	:	11/21/2020

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Directions to “ LISA LEVANDER ” Practice Location

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