Provider Demographics
NPI:1548739931
Name:MEYERS, LISA MARIE
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:MEYERS
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 1:719 ROUTE 522
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1211
Mailing Address - Country:US
Mailing Address - Phone:570-374-1210
Mailing Address - Fax:570-374-5748
Practice Address - Street 1:719 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1211
Practice Address - Country:US
Practice Address - Phone:570-374-1210
Practice Address - Fax:570-374-5748
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist