Provider Demographics
NPI:1326320755
Name:JACKMAN, LISA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:JACKMAN
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 1:20 CELESTIAL WAY
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1293
Mailing Address - Country:US
Mailing Address - Phone:508-364-5953
Mailing Address - Fax:
Practice Address - Street 1:283 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2937
Practice Address - Country:US
Practice Address - Phone:603-889-6124
Practice Address - Fax:603-889-6164
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2110183500000X
MAPH27465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist