Provider Demographics
NPI:1669005781
Name:LISHER, LINDSAY RANAYE
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RANAYE
Last Name:LISHER
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 1:2470 W PULLMAN RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4034
Mailing Address - Country:US
Mailing Address - Phone:208-882-1344
Mailing Address - Fax:208-882-5886
Practice Address - Street 1:1080 LISHER CUT OFF
Practice Address - Street 2:
Practice Address - City:POTLATCH
Practice Address - State:ID
Practice Address - Zip Code:83855-9632
Practice Address - Country:US
Practice Address - Phone:208-964-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCT16972183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician