Provider Demographics
NPI:1215227087
Name:BECKWITH, LISA DONELLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DONELLA
Last Name:BECKWITH
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 1:2100 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2431
Mailing Address - Country:US
Mailing Address - Phone:919-212-2555
Mailing Address - Fax:919-212-2550
Practice Address - Street 1:2100 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2431
Practice Address - Country:US
Practice Address - Phone:919-212-2555
Practice Address - Fax:919-212-2550
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist