Provider Demographics
NPI:1154850691
Name:MIAOULIS, LISA SHERWOOD (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SHERWOOD
Last Name:MIAOULIS
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 1:6495 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4230
Mailing Address - Country:US
Mailing Address - Phone:334-220-2568
Mailing Address - Fax:
Practice Address - Street 1:6495 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4230
Practice Address - Country:US
Practice Address - Phone:334-272-2043
Practice Address - Fax:334-272-0786
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist