Provider Demographics
NPI:1225690589
Name:HANDLEY, LISA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:HANDLEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-2598
Mailing Address - Country:US
Mailing Address - Phone:847-293-3174
Mailing Address - Fax:
Practice Address - Street 1:3605 NW 164TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-2598
Practice Address - Country:US
Practice Address - Phone:847-293-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty