Provider Demographics
NPI:1003139684
Name:MARTIN, LISA BROWN (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BROWN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SHELBY OAKS DR N
Mailing Address - Street 2:STE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7403
Mailing Address - Country:US
Mailing Address - Phone:901-201-5468
Mailing Address - Fax:
Practice Address - Street 1:1710 SHELBY OAKS DR N
Practice Address - Street 2:STE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7403
Practice Address - Country:US
Practice Address - Phone:901-201-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22858183500000X
MS09888183500000X
KY10607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist