Provider Demographics
NPI:1609169523
Name:HOLLE, LISA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:HOLLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 N EAGLEVILLE RD
Mailing Address - Street 2:UNIT 3092
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-3092
Mailing Address - Country:US
Mailing Address - Phone:860-634-3697
Mailing Address - Fax:
Practice Address - Street 1:1232 STORRS RD
Practice Address - Street 2:#6
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2232
Practice Address - Country:US
Practice Address - Phone:860-634-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011838183500000X, 1835P0018X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology