Provider Demographics
NPI:1043429566
Name:CARLISLE, LORRAINE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:M
Last Name:CARLISLE
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 1:5324 RIVER RIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3664
Mailing Address - Country:US
Mailing Address - Phone:505-922-8929
Mailing Address - Fax:
Practice Address - Street 1:10131 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4045
Practice Address - Country:US
Practice Address - Phone:505-897-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist