Provider Demographics
NPI:1013202167
Name:SALYER, LISA BALLARD (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BALLARD
Last Name:SALYER
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 1:2531 TORCROSS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3651
Mailing Address - Country:US
Mailing Address - Phone:910-484-7570
Mailing Address - Fax:
Practice Address - Street 1:3026 BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4043
Practice Address - Country:US
Practice Address - Phone:910-864-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist