Provider Demographics
NPI:1578855599
Name:LYONS, LISA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:LYONS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:LYONS
Other - Last Name:FRALICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3606 MAIN HWY
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1867
Mailing Address - Country:US
Mailing Address - Phone:803-245-1054
Mailing Address - Fax:803-245-1057
Practice Address - Street 1:3606 MAIN HWY
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1867
Practice Address - Country:US
Practice Address - Phone:803-245-1054
Practice Address - Fax:803-245-1057
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist