Provider Demographics
NPI:1598071128
Name:SCHRECK, LISA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SCHRECK
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 1:5336 PROSPERITY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1133
Mailing Address - Country:US
Mailing Address - Phone:704-947-7775
Mailing Address - Fax:704-947-3198
Practice Address - Street 1:5336 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1133
Practice Address - Country:US
Practice Address - Phone:704-947-7775
Practice Address - Fax:704-947-3198
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15096OtherNC LICENSE