Provider Demographics
NPI:1164719761
Name:BECK, LISA RANDI
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RANDI
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PACERS LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1334
Mailing Address - Country:US
Mailing Address - Phone:410-653-2413
Mailing Address - Fax:
Practice Address - Street 1:9901 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3407
Practice Address - Country:US
Practice Address - Phone:410-683-6517
Practice Address - Fax:410-683-6517
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-02
Last Update Date:2011-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist