Provider Demographics
NPI:1083080634
Name:JANSSEN CARLSON, LISA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:JANSSEN CARLSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BLUE JAY AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1380
Mailing Address - Country:US
Mailing Address - Phone:408-394-1046
Mailing Address - Fax:
Practice Address - Street 1:5400 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7049
Practice Address - Country:US
Practice Address - Phone:360-696-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH604795731835P0018X
ORRPH00147571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist