Provider Demographics
NPI:1689981425
Name:DYSARD, LISA R (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:DYSARD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19592 PARK RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9443
Mailing Address - Country:US
Mailing Address - Phone:231-679-0399
Mailing Address - Fax:
Practice Address - Street 1:1035 E WILCOX AVE
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8794
Practice Address - Country:US
Practice Address - Phone:231-689-7156
Practice Address - Fax:231-689-3869
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist