Provider Demographics
NPI:1417178690
Name:MOORHEAD, LISA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:MOORHEAD
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 1:404B WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2810
Mailing Address - Country:US
Mailing Address - Phone:410-221-6400
Mailing Address - Fax:
Practice Address - Street 1:404B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2810
Practice Address - Country:US
Practice Address - Phone:410-221-6400
Practice Address - Fax:410-221-0600
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist