Provider Demographics
NPI:1588027106
Name:GRABOWSKI, LISA (BS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:GRABOWSKI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3325
Mailing Address - Country:US
Mailing Address - Phone:203-393-1213
Mailing Address - Fax:
Practice Address - Street 1:73 WATERBURY RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1252
Practice Address - Country:US
Practice Address - Phone:203-758-3316
Practice Address - Fax:203-758-3185
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0008016183500000X
FLPS 39579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist