Provider Demographics
NPI:1609452580
Name:FARAH, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FARAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26900 CEDAR RD STE 330S
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1148
Mailing Address - Country:US
Mailing Address - Phone:216-839-3097
Mailing Address - Fax:216-839-3974
Practice Address - Street 1:26900 CEDAR RD STE 330S
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1148
Practice Address - Country:US
Practice Address - Phone:216-839-3097
Practice Address - Fax:216-839-3974
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-17772183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist