Provider Demographics
NPI:1366042749
Name:POE, LISA (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 FLYNN CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1775
Mailing Address - Country:US
Mailing Address - Phone:703-468-2465
Mailing Address - Fax:703-468-2446
Practice Address - Street 1:6530 TRADING SQ
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2278
Practice Address - Country:US
Practice Address - Phone:703-468-2465
Practice Address - Fax:703-468-2446
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist