Provider Demographics
NPI:1114901600
Name:RIBBLE, LISA I (BS, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:RIBBLE
Suffix:I
Gender:F
Credentials:BS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9179
Mailing Address - Country:US
Mailing Address - Phone:574-273-4974
Mailing Address - Fax:574-236-5005
Practice Address - Street 1:801 E LASALLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2814
Practice Address - Country:US
Practice Address - Phone:574-237-7688
Practice Address - Fax:574-236-5005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019522A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist