Provider Demographics
NPI:1114249406
Name:GROSS, LISA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:E
Last Name:GROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-9163
Mailing Address - Country:US
Mailing Address - Phone:814-663-7065
Mailing Address - Fax:814-663-8072
Practice Address - Street 1:961 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-9163
Practice Address - Country:US
Practice Address - Phone:814-663-7065
Practice Address - Fax:814-663-8072
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist