Provider Demographics
NPI:1790769057
Name:KIZER, LISA GAIL (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:KIZER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:G
Other - Last Name:TURPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:494 CHISAM RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76272-7347
Mailing Address - Country:US
Mailing Address - Phone:940-726-5038
Mailing Address - Fax:
Practice Address - Street 1:303 BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-8960
Practice Address - Country:US
Practice Address - Phone:940-458-4448
Practice Address - Fax:940-458-3008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0444Medicare UPIN