Provider Demographics
NPI:1740385921
Name:NOLEN, LISA MURASKI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MURASKI
Last Name:NOLEN
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 1:241 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-1839
Mailing Address - Country:US
Mailing Address - Phone:256-825-6104
Mailing Address - Fax:
Practice Address - Street 1:1784 ELKAHATCHEE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4800
Practice Address - Country:US
Practice Address - Phone:256-234-0091
Practice Address - Fax:256-234-4901
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12357OtherPHARMACY LICENSE