Provider Demographics
NPI:1073115903
Name:HOLMES, LISA J J (RPH)
Entity Type:Individual
Prefix:
First Name:LISA J
Middle Name:J
Last Name:HOLMES
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 1:284 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-4340
Mailing Address - Country:US
Mailing Address - Phone:508-654-5749
Mailing Address - Fax:508-824-0994
Practice Address - Street 1:284 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-4340
Practice Address - Country:US
Practice Address - Phone:508-654-5749
Practice Address - Fax:508-824-0994
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist