Provider Demographics
NPI:1598756694
Name:GARNER, LISA DAWN (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
Last Name:GARNER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3628
Mailing Address - Country:US
Mailing Address - Phone:563-324-1641
Mailing Address - Fax:563-884-4480
Practice Address - Street 1:129 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2803
Practice Address - Country:US
Practice Address - Phone:563-324-1641
Practice Address - Fax:563-884-4480
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0004275Medicaid