Provider Demographics
NPI:1679656458
Name:JOKERST, LISA K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:JOKERST
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 1:400 S TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1726
Mailing Address - Country:US
Mailing Address - Phone:636-937-3178
Mailing Address - Fax:636-937-3318
Practice Address - Street 1:400 S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1726
Practice Address - Country:US
Practice Address - Phone:636-937-3178
Practice Address - Fax:636-937-3318
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist