Provider Demographics
NPI:1003197393
Name:SHARP, LISA ELLIOTT (DPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELLIOTT
Last Name:SHARP
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 NW HEINZWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4950
Mailing Address - Country:US
Mailing Address - Phone:580-353-5505
Mailing Address - Fax:
Practice Address - Street 1:723 NW HEINZWOOD CIR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4950
Practice Address - Country:US
Practice Address - Phone:580-353-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist