Provider Demographics
NPI:1073919791
Name:HOUSTON, LISHA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISHA
Middle Name:NICOLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LISHA
Other - Middle Name:NICOLE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1330 S CARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4507
Mailing Address - Country:US
Mailing Address - Phone:870-268-1442
Mailing Address - Fax:870-268-1493
Practice Address - Street 1:1330 S CARAWAY RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4507
Practice Address - Country:US
Practice Address - Phone:870-268-1442
Practice Address - Fax:870-268-1493
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist