Provider Demographics
NPI:1417558909
Name:DEMARINIS, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DEMARINIS
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 1:526 E MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644-9505
Mailing Address - Country:US
Mailing Address - Phone:330-771-0018
Mailing Address - Fax:
Practice Address - Street 1:526 E MOHAWK DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:OH
Practice Address - Zip Code:44644-9505
Practice Address - Country:US
Practice Address - Phone:330-771-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03319836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist