Provider Demographics
NPI:1699860098
Name:CARLSON, LISA PITZER (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PITZER
Last Name:CARLSON
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 1:511 CLEAR CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3931
Mailing Address - Country:US
Mailing Address - Phone:512-894-0041
Mailing Address - Fax:512-475-8218
Practice Address - Street 1:100F WEST DEAN KEETON
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1006
Practice Address - Country:US
Practice Address - Phone:512-471-1824
Practice Address - Fax:512-475-8218
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT23258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist