Provider Demographics
NPI:1790051308
Name:SOBOTKIEWICZ, LISA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SOBOTKIEWICZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ORMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 N WARREN AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2297
Mailing Address - Country:US
Mailing Address - Phone:608-225-4545
Mailing Address - Fax:
Practice Address - Street 1:6462 S 27TH ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1036
Practice Address - Country:US
Practice Address - Phone:414-761-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14133-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist