Provider Demographics
NPI:1619266269
Name:BARR, LISA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:BARR
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 1:27 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1001
Mailing Address - Country:US
Mailing Address - Phone:860-537-9034
Mailing Address - Fax:860-537-9023
Practice Address - Street 1:27 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1001
Practice Address - Country:US
Practice Address - Phone:860-537-9034
Practice Address - Fax:860-537-9023
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6536183500000X
MA19476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist