Provider Demographics
NPI:1093499089
Name:BURGESS, LISA ANNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNETTE
Last Name:BURGESS
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 1:2102 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2677
Mailing Address - Country:US
Mailing Address - Phone:501-950-7575
Mailing Address - Fax:
Practice Address - Street 1:11121 N RODNEY PARHAM RD STE 42B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4108
Practice Address - Country:US
Practice Address - Phone:501-223-2636
Practice Address - Fax:501-224-5253
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist