Provider Demographics
NPI:1639370570
Name:MORE, LISY V (RPH)
Entity Type:Individual
Prefix:
First Name:LISY
Middle Name:V
Last Name:MORE
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 1:301 BROADWAY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-7656
Mailing Address - Country:US
Mailing Address - Phone:256-722-0302
Mailing Address - Fax:
Practice Address - Street 1:8650 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1803
Practice Address - Country:US
Practice Address - Phone:256-461-7812
Practice Address - Fax:256-461-1745
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist