Provider Demographics
NPI:1205201092
Name:RASMUSSEN, LISA ANNE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:50742 BEAR RUN DRIVE
Mailing Address - City:MESA
Mailing Address - State:CO
Mailing Address - Zip Code:81643-0267
Mailing Address - Country:US
Mailing Address - Phone:970-985-0715
Mailing Address - Fax:
Practice Address - Street 1:71 SIPPRELLE DR
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9232
Practice Address - Country:US
Practice Address - Phone:970-285-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO145841835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1043536014Medicaid