Provider Demographics
NPI:1568661643
Name:RATLIFF, LISA A (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:RATLIFF
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 1:6195 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6202
Mailing Address - Country:US
Mailing Address - Phone:208-319-0191
Mailing Address - Fax:208-319-0197
Practice Address - Street 1:6195 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6202
Practice Address - Country:US
Practice Address - Phone:208-319-2312
Practice Address - Fax:208-319-2316
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist