Provider Demographics
NPI:1336288588
Name:LINK, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LINK
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 1:4246 COLONEL DRAKE HWY
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-7106
Mailing Address - Country:US
Mailing Address - Phone:814-674-5409
Mailing Address - Fax:
Practice Address - Street 1:1328 THIRD AVE
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-695-8065
Practice Address - Fax:814-693-2770
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist